Simple Steps Can Combat Sleep Problems in Elderly
WebMD News Archive
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,
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."