1. A program for family and friends caring for older people at home
Sleep Problems
More and more families are caring for older adults at home, and providing that care can be one of the most rewarding experiences but also one of the most challenging.
HealthinAging.org has created this presentation on Sleep Problems to provide you, the caregiver, with advice and guidance to help you navigate this process. The presentation will explain the problem, and provides clear, practical instructions for dealing with caregiving challenges, including when to seek professional help
A program for family and friends caring for older people at home

2. Understanding the Problem
We should start by understanding sleep problems.

3. Understanding the Problem
Sleep is considered a problem only when:
the person is not satisfied with their sleep
when the person feels drowsy the following day
a medical illness may be the cause
People of all ages can have trouble falling asleep or staying asleep (insomnia). There are many possible causes including stress, changes in schedule, diet, or as a side effect of medicines. As people age, they generally spend less time in the deepest stages of sleep. After age 40, sleep becomes lighter and it is easier to wake up. Sleep is considered a problem only when the person is not satisfied with their sleep, when the person feels drowsy the following day, or when the sleep problem suggests a serious underlying illness.
Sometimes making a few simple lifestyle changes, such as getting more exercise during the day, is all that is necessary for a person to begin sleeping soundly. At other times drinking alcoholic beverages or health problems such as stress, hormonal changes, or poor nutrition may cause insomnia.

4. Understanding the Problem
The most common reasons for a sudden change in sleep patterns are:
Stress or nervousness
Depression
Dementia
The most common reasons for a sudden change in sleep patterns are:
stress or nervousness
Depression, which can keep people up and wake them at early hours
Dementia, which frequently alters sleep/wake patterns. A person with dementia may sleep during the daytime then stay awake and even wander at night.
Medicines such as diuretics, antidepressants, anti-anxiety medicines, painkillers, and drugs for Parkinson's disease can also affect sleep patterns.

5. Understanding the Problem
Sometimes people show odd behaviors while sleeping
One disorder to be concerned about is sleep apnea
Sometimes people show odd behaviors while sleeping, which may be noticed only by a spouse or companion. Behaviors such as moving the arms or legs, kicking, loud snoring, or choking sounds are signs of possible sleep disorders. These should be brought to the healthcare provider’s attention.
One disorder to be concerned about is sleep apnea, a sleeping condition in which people briefly stop breathing. This causes them to wake up many times during the night. Sleep apnea can cause fatigue the next day and is associated with high blood pressure, heart disease, and heart failure.

6. Understanding the Problem
Your goals are to:
Encourage a set routine for going to bed and waking up
Check all medicines to see if they could affect sleep
Check the use patterns of diet, caffeine, and alcohol to see if they might be affecting sleep
Make the bedroom safe and comfortable

7. When to Get Professional Help
Sleep emergencies are not common. However, the following situation has been known to happen at night or bedtime.
When to call the healthcare provider immediately or go to the emergency room

8. Call the Healthcare Provider Immediately If
The older person wakes suddenly during the night and acts agitated or confused
If the person you are caring for wakes suddenly during the night and acts agitated or confused, it is important to call a healthcare provider right away. This could be a sign of a serious medical illness or a side effect of a prescription drug.

9. When to Get Professional Help
Call the healthcare provider during office hours to discuss the following problems:
When to call the healthcare provider during office hours

10. Call the Healthcare Provider During Office Hours if
The older person’s sleep is not satisfying
Ask the older adult what is troublesome about sleep.

11. Call the Healthcare Provider During Office Hours if
Sleep or fatigue cuts into daytime activities
It is normal to fall asleep during quiet time, such as watching TV, but falling asleep in the middle of a conversation is not. Excessive daytime sleepiness is also abnormal. Falling asleep while driving is abnormal and dangerous.

12. Call the Healthcare Provider During Office Hours if
You see or hear strange behaviors during the older person’s sleep
The following behaviors could all be signs of sleep apnea or other sleep disorders:
Loud snoring
choking sounds
short periods when breathing stops
Gasping
leg and arm movements during sleep

13. Know the Answers to the Following Questions Before Calling
How long has sleeping been a problem?
What other medical conditions does the older person have?
What medicines are taken? (Include prescription and non-prescription drugs)
Could stress be affecting sleep, such as the recent death of a family member?

14. Know the Answers to the Following Questions Before Calling
Is he or she feeling sad, depressed, or anxious?
Is snoring a problem? If yes, do you notice daytime drowsiness and/or choking, gasping sounds during sleep?
Are there complaints of indigestion, chest pain, or shortness of breath when the older person wakes up during the night?
Is there evidence of use of alcohol, caffeine, or nicotine?

15. What You Can Do To Help
There are many things that you can do, on your own, to help an older person with sleep problems.

16. What You Can Do To Help Use sleep medicines with caution
Read the label on the medicine bottle carefully. Most prescribed sleep medicines are meant to be taken for no longer than two or three weeks. After three weeks, they lose effectiveness and can cause drowsiness during the day. Over-the-counter sleeping pills can cause dry mouth, constipation, urinary problems, and confusion.

17. What You Can Do To Help
Help the older person maintain a regular sleep/wake schedule
As much as possible, older people should get up and go to bed around the same time every day. But it is also important that they go to bed when they are sleepy. There is no need to lie in bed awake worrying about not sleeping.

18. What You Can Do To Help
Encourage the older person to get out of bed if not asleep in 30 minutes
Getting out of bed and going into another room for a short period can help people who are having trouble sleeping. Listening to music or doing some light reading often helps feelings of tiredness to return. However, it is important to avoid bright light during these periods.

19. What You Can Do To Help Encourage the older person to limit napping
Naps of up to one hour are often helpful. Naps taken in the middle of the day (around noon) are the most effective. However, napping for more than an hour will make it more difficult for the older person to sleep at night.

20. What You Can Do To Help Encourage daytime exercise
Exercise is a good remedy for poor sleep. A brisk walk in the afternoon is best. However, exercising just before going to bed can cause difficulty in falling asleep.

21. What You Can Do To Help
Help the older person to limit or cut out alcohol, caffeine, and nicotine
All of these substitutions can interfere with sleep.

22. What You Can Do To Help
Encourage the older person not to use the bed to eat, read, or watch TV
When the bedroom is used just for sleeping, it becomes associated with sleep. This can help the older person feel sleepy when in the room.

23. What You Can Do To Help
Help the older person develop a bedtime routine
Activities like washing the face, brushing teeth, and other nightly routines before bed can help the older person relax and prepare for sleep.

24. What You Can Do To Help Make the bedroom comfortable and safe
Sometimes the noise of a fan running or a “white noise” machine helps people sleep. Have a nightlight in case the older person wakes up confused or agitated. For people who wander at night, secure doors and windows.

25. What You Can Do To Help Keep a diary of the older person’s sleep
If sleeplessness is a problem, keep a record of the sleep patterns for several weeks to review with the healthcare provider. Record the following information on a daily basis:
Times waking up and going to bed.
How long it took to fall asleep.
The number of times awake during the night and for how long.
What woke the older person during the night.
Any strange behavior during sleep, such as choking or gasping sounds, stopped breathing, or movements of the legs.
When and how long naps are.
Use of alcohol, caffeine, or sleeping pills.
A two-week sleep diary can help the healthcare provider understand the problem and determine what treatments would be helpful. Sometimes a sleep diary shows that the older person’s sleep is better than you thought.

26. Carrying Out Your Plan
Even when you have excellent plans, there are obstacles or problems that may prevent you from carrying out your plans. Here are some examples.

27. Possible Problems Carrying Out Your Plan
“If he stops taking sleeping pills, he won't be able to sleep.”
“Sleeping problems are normal for old people.”
“If he stops taking sleeping pills, he won't be able to sleep.”
Long-term use of sleeping pills may be contributing to or even causing the problems with sleep.
“Sleeping problems are normal for old people.”
This is not true. Although there are some changes in sleep as people get older, most sleeping problems can be solved or improved.

28. Possible Problems Carrying Out Your Plan
“She always takes a nap before dinner.”
“She always takes a nap before dinner.”
The nap may be the reason for being unable to sleep at night. If the nap is a needed rest period, then it is okay. If napping is because of boredom, it may lead to less sleep at night.

29. Possible Problems Carrying Out Your Plan
Think of other problems that could interfere with carrying out your plan.
What other problems could get in the way of doing the things suggested in this presentation? For example, will the older person cooperate? Will other people help? How will you explain your needs to other people? Do you have the time and energy to carry out this plan?
You need to make plans for solving these problems.

30. Checking on Progress Progress may be slow, especially at first
Progress may be slow, especially at first. If you are setting up new routines to promote sleep, it usually takes time for people to get used to new routines and for them to be effective. Be on the look out for sleep problems related to medical conditions or disorders, like sleep apnea, which require medical treatment.
Set realistic goals. A person is unlikely to sleep eight hours at night if they have only slept four to five hours a night for years.

31. If Your Plan Isn’t Working
Brainstorm ideas of your own
Ask the healthcare providers for help
Be sure you have tried all of the suggestions in the “What You Can Do to Help” section and be realistic about how quickly you can expect change. Brainstorm ideas of your own. You may find the best approach through trying different methods.
If problems with sleep are increasing and are of major concern to the older person, ask the healthcare providers for help. Tell them what you have done and what the results have been.

32. Copyright © 2015 by the AGS Health in Aging Foundation
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This Caregiving Tips program is based on the 2004 Eldercare at Home, 2nd Edition presentation kit, and has been updated by the AGS Public Education Committee.
Copyright © 2015 by the AGS Health in Aging Foundation
For more information, visit the AGS Health in Aging Foundation’s website or call the toll free number provided above.