Which medications are used to improve sleep patterns in patients with sleep disturbances select all that apply?

Sleep normally occurs in several stages. The sleep cycle includes:

• Dreamless periods of light and deep sleep
• Some periods of active dreaming (REM sleep)

The sleep cycle is repeated several times during the night.

AGING CHANGES

Sleep patterns tend to change as you age. Most people find that aging causes them to have a harder time falling asleep. They wake up more often during the night and earlier in the morning.

Total sleep time stays the same or is slightly decreased (6.5 to 7 hours per night). It may be harder to fall asleep and you may spend more total time in bed. The transition between sleep and waking up is often abrupt, which makes older people feel like they are a lighter sleeper than when they were younger.

Less time is spent in deep, dreamless sleep. Older people wake up an average of 3 or 4 times each night. They are also more aware of being awake.

Older people wake up more often because they spend less time deep sleep. Other causes include needing to get up and urinate (nocturia), anxiety, and discomfort or pain from long-term (chronic) illnesses.

EFFECT OF CHANGES

Sleep difficulty is an annoying problem. Long-term (chronic) insomnia is a major cause of auto accidents and depression. Because older people sleep more lightly and wake up more often, they may feel deprived of sleep even when their total sleep time has not changed.

Sleep deprivation can eventually cause confusion and other mental changes. It is treatable, though. You can reduce symptoms when you get enough sleep.

Sleep problems are also a common symptom of depression. See a health care provider to find out whether depression or another health condition is affecting your sleep.

COMMON PROBLEMS

• Insomnia is one of the more common sleep problems in older people.
• Other sleep disorders, such as restless legs syndrome, narcolepsy, or hypersomnia can also occur.
• Sleep apnea, a condition where breathing stops for a time during sleep, can cause severe problems.

PREVENTION

Older people respond differently to medicines than do younger adults. It is very important to talk with a provider before taking sleep medicines. If possible, avoid sleep medicines. However, antidepressant medicines can be very helpful if depression affects your sleep. Some antidepressants do not cause the same side effects as sleep medicines.

Sometimes, a mild antihistamine works better than a sleeping pill for relieving short-term insomnia. However, most health experts do not recommend these types of medicines for older people.

Use sleep medicines (such as zolpidem, zaleplon, or benzodiazepines) only as recommended, and only for a short time. Some of these medicines can lead to dependence (needing to take the drug to function) or addiction (compulsive use despite adverse consequences). Some of these drugs build up in your body. You can develop toxic effects such as confusion, delirium, and falls if you take them for a long time.

You can take measures to help you sleep:

• A light bedtime snack may be helpful. Many people find that warm milk increases sleepiness, because it contains a natural, sedative-like amino acid.
• Avoid stimulants such as caffeine (found in coffee, tea, cola drinks, and chocolate) for at least 3 or 4 hours before bed.
• Do not take naps during the day.
• Exercise at regular times each day, but not within 3 hours of your bedtime.
• Avoid too much stimulation, such as violent TV shows or computer games, before sleep. Practice relaxation techniques at bedtime.
• Do not watch television or use your computer, cell phone, or tablet in the bedroom.
• Try to go to bed at the same time every night and wake at the same time each morning.
• Use the bed only for sleep or sexual activity.
• Avoid tobacco products, especially before sleep.
• Ask your provider if any of the medicines you take may affect your sleep.

If you cannot fall asleep after 20 minutes, get out of bed and do a quiet activity, such as reading or listening to music.

When you feel sleepy, get back in bed and try again. If you still cannot fall asleep in 20 minutes, repeat the process.

Drinking alcohol at bedtime may make you sleepy. However, it is best to avoid alcohol, because it can make you wake up later in the night.

RELATED TOPICS

• Aging changes in the nervous system
• Insomnia

Barczi SR, Teodorescu MC. Psychiatric and medical comorbidities and effects of medications in older adults. In: Kryger M, Roth T, Dement WC, eds. Principles and Practice of Sleep Medicine. 6th ed. Philadelphia, PA: Elsevier; 2017:chap 151.

Bliwise DL, Scullin MK. Normal aging. In: Kryger M, Roth T, Dement WC, eds. Principles and Practice of Sleep Medicine. 6th ed. Philadelphia, PA: Elsevier; 2017:chap 3.

Sterniczuk R, Rusak B. Sleep in relation to aging, frailty, and cognition. In: Fillit HM, Rockwood K, Young J, eds. Brocklehurst's Textbook of Geriatric Medicine and Gerontology. 8th ed. Philadelphia, PA: Elsevier; 2017:chap 108.

Walston JD. Common clinical sequelae of aging. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 22.

Updated by: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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