Silver Age Health | Pay attention to insomnia problems among the elderly

Good sleep is essential. Globally, 27% of people suffer from sleep disorders, and among the elderly, this proportion is as high as 40% to 70%. Such sleep disorders not only put the elderly at a higher risk of dementia, depression, anxiety and cardiovascular disease, but may also lead to a series of problems such as social isolation, functional decline, increased risk of falls, and impaired cognitive function. So how can we improve the sleep quality of the elderly?

▏Several forms of insomnia in the elderly

Insomnia, a seemingly simple term, actually includes many forms and causes. It is not just a simple state of being unable to fall asleep, but also includes a variety of different psychological and physiological experiences. Below, we will take a closer look at the five main forms of insomnia.

The first is difficulty falling asleep, also known as insomnia. In this case, people tend to toss and turn in bed and have difficulty falling asleep. This may be caused by factors such as stress, anxiety or irregular lifestyle.

The second is difficulty maintaining sleep, also known as intermittent insomnia. In this case, people wake up multiple times during the night and then cannot fall asleep again. This can be caused by physical discomfort, environmental factors (such as noise, light) or psychological stress.

The third type is early awakening, which is waking up much earlier than usual and being unable to fall asleep again after waking up. This may be caused by a disordered biological clock, depression or other psychological problems.

The fourth type is non-restorative sleep, also known as poor sleep quality. In this case, although people are able to fall asleep and sleep enough, they do not feel fully rested and restored after waking up. This may be caused by factors such as poor sleeping environment, high psychological stress or certain chronic diseases.

The fifth is excessive sleep, which is not a common form of insomnia, but it is also worth our attention. In this case, people will feel sleepy, weak, and even need a long sleep to restore their energy. This may be caused by factors such as physical illness, side effects of medication, or psychological problems.

The sixth type is chronic insomnia, which occurs more than 3 times a week for more than 3 months and cannot be explained by other sleep disorders. In addition to physiological and psychological factors, physical factors, behavioral and environmental factors, the possible factors of chronic insomnia in the elderly include drug-induced factors. For example, hormone drugs cause sympathetic nervous system excitement, diuretics cause frequent urination, and people who take hypnotic drugs suddenly withdraw their drugs. Taking drugs such as isoniazid and phenytoin sodium also has adverse reactions of sleep disorders. Other drugs such as thyroxine, theophylline, quinolone antibiotics, and central antihypertensive drugs can also cause senile insomnia.

▏Medication

How to effectively treat insomnia in the elderly has become the focus of medical and social attention. Drug treatment, as one of the methods, has the characteristics of rapid onset and significant effects, but it also has some potential risks and side effects.

1. Choice and principles of drug treatment

When choosing medication, we need to fully consider the patient's specific condition, including the cause, duration, severity, and other accompanying diseases of insomnia. Elderly people often have multiple chronic diseases, such as high blood pressure, diabetes, heart disease, etc. Therefore, when choosing medication, we should avoid using medications that may aggravate these diseases.

In principle, medication should first be individualized, that is, a treatment plan should be developed based on the specific circumstances of each patient. Secondly, the principle of short-term use should be followed, and long-term use of drugs should be avoided to avoid drug dependence and side effects.

For the treatment of insomnia in the elderly, in addition to drug treatment, we should also pay attention to non-drug treatment methods, such as cognitive behavioral therapy, improving lifestyle habits, etc., to comprehensively improve the sleep quality of the elderly.

2. Commonly used drugs and their mechanisms of action

At present, the drugs commonly used in clinical treatment of insomnia in the elderly mainly include benzodiazepines, non-benzodiazepines, melatonin receptor agonists, etc. These drugs improve patients' sleep quality through different mechanisms of action. Benzodiazepines mainly promote sleep by enhancing the inhibitory effect of GABA (γ-aminobutyric acid), but long-term use may cause problems such as cognitive dysfunction and drug dependence. Non-benzodiazepines have a faster onset and fewer side effects, but may also cause headaches, nausea and other discomforts. Melatonin receptor agonists regulate the sleep-wake cycle by simulating the effects of melatonin, but their effects vary among different patients.

3. Precautions for drug treatment

There are some things to note when using medication to treat insomnia in the elderly.

1. Make a clear diagnosis

Before choosing medication to treat insomnia for the elderly, first make sure that the diagnosis of insomnia is clear. Insomnia may be caused by a variety of reasons, such as physiological changes, psychological stress, environmental factors, etc. Doctors need to rule out potential diseases that may cause insomnia, such as depression, anxiety, chronic obstructive pulmonary disease, etc., through detailed interviews and necessary examinations. Only on the basis of a clear diagnosis can appropriate medication be selected for treatment.

2. Choose the right medicine

Drug treatment for insomnia in the elderly needs to consider the safety, effectiveness and potential side effects of the drug. For the elderly, drugs with a short half-life are preferred to reduce the occurrence of next-day residual effects. In addition, the interaction between the drug and other drugs being taken should be considered to avoid potential drug conflicts.

3. Start with a small dose

Elderly people are often more sensitive to drugs than young people, so when starting drug treatment, you should start with a smaller dose and closely observe the efficacy and side effects of the drug. If a small dose of the drug can effectively improve sleep, there is no need to increase the dose. If the effect is not good, you can gradually increase the dose under the guidance of a doctor, but be sure to avoid overdose.

4. Regular monitoring

During drug treatment, the physical condition and drug response of the elderly need to be monitored regularly. This includes observing whether there is any discomfort, side effects or signs of drug dependence. At the same time, it is also necessary to regularly evaluate the degree of improvement of sleep quality by drugs so as to adjust the drug dosage or change the drug in time.

5. Pay attention to drug discontinuation

When the insomnia symptoms of the elderly are improved or drug treatment is no longer needed, the use of drugs should be gradually stopped under the guidance of a doctor. Sudden discontinuation of medication may cause rebound insomnia symptoms or other adverse reactions. Therefore, during the discontinuation process, it is necessary to pay close attention to the physical condition of the elderly and adjust the discontinuation plan at any time.

6. Psychological and lifestyle adjustments

Although drug treatment is one way to solve the problem of insomnia in the elderly, it is not the only way. While taking drug treatment, we also need to pay attention to the mental state and lifestyle of the elderly. Through psychological counseling, relaxation training, and adjusting work and rest schedules, we can help the elderly improve their sleep quality and reduce drug dependence.

IV. Conclusion and Outlook

Drug therapy plays an important role in the treatment of insomnia in the elderly, but it is also necessary to comprehensively consider the patient's specific situation and the side effects of the drug. In the future, with the deepening of medical research and the continuous innovation of drugs, we expect that safer and more effective drugs will be available to treat insomnia in the elderly. At the same time, it is also necessary to strengthen publicity and education on insomnia in the elderly, improve the public's awareness and attention to the problem of insomnia, and create a healthier and more comfortable sleeping environment for the elderly.

▏ In terms of drug use

1. Zopiclone and eszopiclone have central nervous system inhibitory effects and should be taken before bedtime. After taking these drugs, you should avoid engaging in potentially dangerous activities the next day and should not use them with alcohol.

2. Currently, benzodiazepines are no longer recommended as the first choice for the treatment of insomnia, especially for the elderly and patients with special medical diseases. Long-term use of these drugs can easily lead to dependence. If they must be used, the time of use should be limited as much as possible. These drugs include but are not limited to estazolam, alprazolam, clonazepam, diazepam and lorazepam.

3. Melatonin drugs are mainly used to treat chronic insomnia in middle-aged and elderly patients over the age of 55. These drugs have a better effect in treating this group of people.

4. Chronic insomnia patients can also consider using antidepressants as part of their treatment, depending on their specific circumstances. However, when using these drugs, they should be based on the doctor's advice and closely monitored for any adverse reactions.

▏ Exercises suitable for treating insomnia in the elderly

In addition to drug treatment, many elderly people may prefer to improve insomnia through exercise. Here are some exercises suitable for treating insomnia in the elderly and analyze their mechanisms of action.

1. Mild aerobic exercise

Mild aerobic exercise such as walking, Tai Chi and yoga are very suitable for the elderly. These exercises can increase blood circulation, promote metabolism, and help the body relax, making it easier to fall asleep. At the same time, they can also improve the elderly's cardiopulmonary function and enhance the body's resistance.

1. Walking: Walking in the morning or evening is one of the favorite sports for the elderly. It not only helps the elderly breathe fresh air, but also promotes blood circulation in the body and helps sleep at night.

2. Tai Chi: Tai Chi is a slow and smooth exercise that emphasizes the coordination of breathing and movement. By practicing Tai Chi, the elderly can relax their body and mind while improving their body flexibility and balance.

3. Yoga: Yoga helps the elderly achieve harmony of body and mind through a series of postures and breathing exercises. Yoga can relax tense muscles and reduce stress, thus helping to improve insomnia.

2. Flexibility Training

Flexibility training such as stretching exercises can help the elderly relieve body stiffness and improve joint flexibility, thereby reducing insomnia caused by physical discomfort at night.

1. Stretching exercises: By stretching various parts of the body, such as arms, legs, waist, etc., it can help the elderly relieve muscle fatigue and tension and improve sleep quality.

2. Stretching exercises: Stretching exercises can further relax muscles and prevent muscle pain and stiffness. The elderly can do simple stretching exercises before going to bed, such as stretching their arms and turning their necks, to help their bodies relax.

3. Balance Training

As they age, the balance ability of the elderly gradually declines, which may cause them to fall or become unstable when getting up at night. Through balance training, such as standing on one foot and stepping on a balance ball, the elderly can improve their balance ability, reduce nighttime accidents, and thus improve sleep quality.

1. Stand on one leg: The elderly can try to close their eyes, stand on one leg, lift the other leg, and hold for a few seconds before switching to the other leg. This exercise can help the elderly improve their sense of balance.

2. Step on a balance ball: In a stable environment, the elderly can try to step on a balance ball and maintain balance by adjusting the center of gravity of the body. This exercise can not only improve balance ability, but also exercise core muscles.

IV. Precautions

Although exercise can help the elderly improve insomnia, they also need to pay attention to the following points when exercising:

1. Avoid strenuous exercise before bedtime, as this may stimulate the body and make it difficult to fall asleep.

2. Choose the appropriate exercise method and intensity according to your physical condition to avoid physical injuries caused by excessive exercise.

3. If you feel unwell or your insomnia symptoms worsen after exercise, you should stop exercising and consult a doctor.

In addition, traditional Chinese medicine techniques such as Ba Duan Jin, Yi Jin Jing, and Wu Qin Xi are gentle and slow, suitable for the elderly with weak constitutions; long-term practice can regulate the functions of the heart, liver, lungs and other internal organs, achieve the purpose of harmonizing the Ying and Wei, balancing yin and yang, unblocking the meridians, and promoting the circulation of qi and blood in the human body. (Picture from the Internet)

Author | Han Mei is a practicing pharmacist who has worked in a well-known national tertiary hospital for more than 30 years and has rich medical care experience. She has represented the hospital on many occasions to go out for exchanges and study. She is an expert in food hygiene and nutrition, has a national nutritionist qualification, and is a science enthusiast.