Simple Steps Can Combat Sleep Problems in Elderly
Apnea can be treated by behavior modifications to lessen sleeping on the back, oral appliances that enhance the airway, weight loss, and elimination of medications that depress breathing. Sometimes respiratory stimulants, such as Diamox (acetazolamide); continuous positive airway pressure, which is administered through a mask the person wears at night; and surgery are also effective. Treatments for periodic limb movement disorders are less than ideal, according to the report. Although medications called benzodiazepines, including Klonopin (clonazepam) and Restoril (temazepam), can be used, they also cause daytime sedation and have little effect on the leg movements themselves, Vitiello writes.
Often the most effective approach to improving slumber is to ensure proper sleep "hygiene," which refers to "all the daily practices or routines that can either promote or impede nighttime rest." Some activities that help induce sleep are sticking to a regular bedtime, establishing pre-sleep rituals such as bathing, a light snack, or reading, exercising regularly but not within four hours of bedtime, refraining from caffeine within six hours of bedtime, avoiding smoking close to bedtime, taking a midafternoon nap, and avoiding alcohol and sleeping pills.
In reviewing this report for WebMD, Alon Avidan, MD, a neurologist at the University of Michigan Sleep Disorders Center in Ann Arbor, had high praise for Vitiello's suggestions to improve sleep hygiene. "The guidelines for good sleep hygiene should really be emphasized because this is exactly what we tell people who come to the sleep clinic," Avidan says. "If patients would follow some of these guidelines we could eliminate half of the visits to the clinic. Some of them have very bad sleep habits."
He also supported Vitiello's position that medications are overused. "The vast majority of people I see are on some sort of [benzo]diazepine and that is not a good thing. I try not to use Klonopin or narcotics because they generally disturb the sleep [patterns] and can exacerbate the apnea." However, he disagreed with Vitiello's medication suggestions for restless leg syndrome. "I have had good results with pramipexole, a dopamine 3 agonist," a medication that also sells as Mirapax.
In describing his approach to sleep problems, Avidan says, "We tell patients that [sleep changes] are physiological and that there are certain guidelines that they can follow that will help them. We help with relaxation techniques. ... What we are doing is treating the underlying medical problem causing the insomnia, reducing the drugs that they don't need to take, having them reduce alcohol to no more than half a glass."