Sleep often becomes more difficult as we get older. For some people the problem is getting to sleep, for others it is staying asleep. Either way, lying in the dark while the rest of the house is sleeping is not only frustrating; it can be hard emotionally as the mind seems to race in directions beyond control.
While sleeping pills might seem like a quick fix they can be more of a problem than a help, especially in the elderly. They may leave a person feeling sluggish and “hung over” the next day. They increase the risk of falls. And if sleep apnea is a problem, they may prevent your parent from waking up to breathe.
The very first thing to do is talk to your parent’s physician and treat any medical problems that might be interfering with sleep such as pain, sleep apnea or restless leg syndrome. This includes reviewing any medications that might interfere with sleep.
If you have eliminated the medical reasons or treated them and sleep is still a problem here are some things to try:
Environment: While cooler temperatures make sleeping easier for most of us, many older people sleep better with a little warmth. Socks, tee shirts, an extra blanket or long-sleeved shirts will help. A hot water bottle or “bed buddy” as my grandma called her warmed, rice filled bag that we placed at her feet, is often soothing. Avoid electric heating pads as these increase the risk for burns, especially with the elderly. Some people like to sleep with a pet for warmth and to snuggle with.
The room should be dark or semi-dark, though if your parent is prone to get up for toileting make sure there is enough light to prevent falls.
Sound: As they age, many people find they sleep lighter and any noise will wake them up. White noise from a fan, window air conditioner or even a sound machine that plays different sounds such as the ocean or crickets chirping may be helpful. Soft music, guided meditations, or a radio will help block noise from the home. Some people like to fall asleep to a television but I only recommend this if you can put it on a timer. The flickering light produced by televisions can interrupt sleep patterns.
Routine: Establishing a bedtime routine will help train the body to get ready for sleep. Many people find reading a relaxing way to unwind just before bed. Other’s like to go to sleep just after the late news or a favorite show. Try to go to bed at the same time every evening. A warm bath or shower may help or a gentle back rub.
Get Natural Sunlight: Open the blinds or curtains. Sunlight stimulates the body’s natural internal clock and helps reduce depression. Exercise as tolerated. Sit outside if weather permits.
Avoid: Exercising should be done during the day to avoid over stimulation near bed time. Alcohol close to bedtime interferes with sleep patterns. Snacks at bed time should be light. Avoid foods that cause heartburn, especially at supper time. Decrease fluids in the evening to avoid toileting interrupting sleep. Naps during the day should be limited to no more than 20 minutes. Nicotine is also a stimulant and some people will wake up at night to smoke. Caffeine should be avoided in the evening.
Warm milk: Milk, dairy and protein-rich foods contain an amino acid called tryptophan that might help you fall asleep but it needs to be taken with a carbohydrate such as crackers. Here is an article that gives a little more insight (This can be your excuse for milk and cookies at bedtime).
Two things I have found that will help with sleep without making me feel groggy the next day are melatonin and magnesium. Melatonin is a hormone naturally produced by your body and regulates your sleep cycles. Light, especially sunlight, helps determine how much your body produces. Before trying it, or any supplement, your healthcare professional should be consulted. For best effect, melatonin should be taken an hour or two before bedtime and no more than 3 mg. In some people it may cause changes in blood pressure, vivid dreams and daytime grogginess.
Magnesium is a mineral found in a variety of foods and is essential for body function and bone growth. According to the National Institutes of Health Office of Dietary Supplements, “Dietary surveys suggest that many Americans do not get recommended amounts of magnesium, symptoms of magnesium deficiency are rarely seen in the US. However, there is concern that many people may not have enough body stores of magnesium because dietary intake may not be high enough. Having enough body stores of magnesium may be protective against disorders such as cardiovascular disease and immune dysfunction.”
What does this have to do with insomnia? Too much magnesium has two side effects: diarrhea and drowsiness. (For some people we can solve two problems with one treatment!) Usually 500 mg at bedtime is enough, though it may have to be taken for a day or two if your parent’s level is a bit low. Definitely decrease the amount if diarrhea occurs and don’t take this long-term without discussing it with your doctor. It is rare to see magnesium toxicity but it does happen. Do not try this if there are kidney problems without discussing it with your parent’s doctor first due to increase risk of toxicity.
Finally, if sleep continues elusive after 20 minutes, get up. Read, write a letter, knit, crochet, watch television, listen to music or some other relaxing activity, until sleepy.