When the Sun Goes Down, Older Adults' Fears Often Take Over
An 86-year-old woman is suffering from dementia. During the day, it regularly sends her into states of confusion. But at night, this senior's situation worsens considerably. She's terrified in the dark, often not knowing where she is or whom she's with. Across the city, another older adult also fears nights. She wonders who might know she's alone, and if they'll break into her house and rob her - or worse.
Whether the causes are physical, psychological or related to a disease such as Alzheimer's or other dementia, the Home Instead Senior Care network has found that nighttime can be very frightening for seniors - especially those who live alone. Many problems that occur at night with seniors are rooted in physical changes that result from aging, many of which are often connected to sleep disorders.
In a 2005 Gallup poll of 1,000 adults over age 50, less than half surveyed (32 percent) reported getting a good night's sleep all seven days of the week. Yet respondents ranked good sleep as more important even than interpersonal relationships.
The Gallup study revealed a number of factors - including worry - that help explain these sleep problems, according to Dr. Harrison Bloom, senior associate and director of the Clinical Education Consultation Service of the International Longevity Center - USA , in New York City. Bloom, a geriatrician, wants to help seniors and home health care providers identify solutions for sleep-related disorders in older adults. Home Instead Senior Care already knows of one: elderly companionship.
"The seniors we serve often face challenges at night that disturb their sleep and peace of mind," said Paul Hogan, CEO of Home Instead Senior Care. "Our CAREGivers are regularly called upon to provide overnight care for seniors and assist them with the anxiety that often sets in at night."
Seniors' sleep problems can be rooted in many sources. "There are physiological changes occurring with age, such as decreased amounts of time spent in certain stages of sleep," Bloom said. "And many also have diseases that make sleep difficult. For instance, people who suffer from congestive heart failure can't rest in a flat position. For others, the pain of arthritis keeps them awake. Medications for certain diseases can affect sleep. And bladder or prostate problems prompt many people to get up for bathroom breaks. These types of interruptions can fragment sleep."
Dr. Sonia Ancoli-Israel, professor of psychiatry at the University of California at San Diego and director of the Sleep Disorders Clinic at the Veterans Affairs San Diego Healthcare System, agrees that it's not necessarily the aging process that disturbs sleep, but rather the many physiological changes that accompany getting older. "In addition to those medical illnesses and medications common in older adults, there can be psychiatric problems and changes in circadian rhythms."
These rhythms help determine when we sleep, and they change as we age. Ancoli-Israel conducted a study five years ago that exposed patients with dementia living in nursing homes to either morning or evening bright light in an effort to adjust the body's circadian rhythms. Both techniques improved nighttime sleep.
But although research is helping to identify solutions, statistics indicate that more seniors are seeking medical remedies to their sleep problems. Between 2000 and 2004, use of prescription insomnia drugs rose by 16 percent among people 65 years and older, according to an analysis recently released by the prescription management firm Medco Health Solutions of Franklin Lakes, NJ.
While there are certainly any number of sleep aids on the market, sleep medications might not be the best answer for all older adults, according to Dr. Sharon Brangman, professor of medicine and division chief, geriatrics, at SUNY Upstate Medical University in Syracuse, NY. They may make seniors confused and disoriented - symptoms that, in particular, should not be exaggerated in seniors who already suffer from them due to Alzheimer's disease or other dementias. And those symptoms can wreak nighttime havoc in the lives of both seniors and their family caregivers.
"I have an 80-year-old Alzheimer's patient who is very anxious and nervous during the afternoon," Brangman said. "She then naps in front of a television in the evening and doesn't want to sleep at night. Her husband - her primary caregiver - is exhausted by the end of the day but he's afraid to sleep at night because she might wander. When she does go to sleep, he often lets her sleep until noon. We encourage him not to let her sleep during the day, and suggest activities for her and respite breaks for him."
While the issues of older adults with dementia-related illnesses are very different from those faced by seniors with sleep disorders and physical ailments, all of these factors contribute to psychological anxiety seniors may experience at night.
"Many seniors undoubtedly are anxious because they know it's harder to reach help at night," Ancoli-Israel said. "There's also more time to think about all of the things that might be going wrong."
This is one of the most important reasons why companionship can be such a help in dealing with these nighttime anxiety problems, according to Hogan.
"The 86-year-old woman with dementia we were introduced to at the beginning of the story - when she awoke at night, she was promptly reassured by her overnight CAREGiver," Hogan said. "As for the woman who was constantly afraid of her home being broken into at night, efforts were made to secure her home, to include adding lighting at the front and back of her house. It's those kinds of 'extras' that can mean the difference between seniors having peace of mind, or of being afraid in their own homes."