Treatment of insomnia in the elderly folk remedies. How to overcome insomnia in old age

What to buy sleeping pills without prescriptions for the elderly? This question can be heard in a pharmacy from a person of age, and from a young woman who has come to buy a cure for insomnia for her mother or grandmother. Indeed, sleep problems are very common in older people, and they are not as safe as they seem at first glance, and the sleep disorder that has arisen cannot be ignored.

How can you describe the dream of an elderly person?

If we consider how a person sleeps in age, then we can observe the following picture:

• lies for a long time, trying not to interfere with the sleep of the rest of the family;
• after some time, sometimes after several hours, such lying down, drowsiness sets in, turning into light sleep;
• with a slight sound or with a change in body position, a person wakes up.

During the night, there are about five such cycles of falling asleep and waking up, and in the morning a person feels tired and weak instead of cheerfulness. Many associate this condition with old age and the natural fading of activity, but in fact these are the consequences of lack of sleep.

If insomnia continues for a long time, then the character of the old people deteriorates, appears:

• irritability;
• touchiness;
• causeless discontent;
• pettiness.

Probably, many have seen such old people who are ready to be offended over trifles and argue over any reason. Younger people explain their behavior to themselves by a harmful senile character, but in fact old man just didn't get enough sleep.

If sleep deprivation continues long time, then the following may occur:

• impaired thinking;
• memory problems;
• hallucinations.

Familiar? This is what it looks like senility, but it could have been prevented if the old man himself or his relatives had taken care of a good night's rest.

Before choosing a medicine, it is worth analyzing why it is difficult for older people to fall asleep and their sleep is not very strong.

All reasons are divided into:

• external;
• internal.

External

In older people, the synthesis of the hormone melatonin, which is responsible for good sleep, noticeably decreases, and disrupt the full night rest could the following:

If only these factors prevent you from getting enough sleep, then you can purchase sleeping pills for the elderly.

Insomnia occurs not only for relatively harmless reasons, it can be a sign of a serious illness.

Self-selection of drugs can not be done in the following cases:

If there are signs of any of the listed diseases, a medical consultation is necessary for the selection of medicines.

If there is any doubt whether insomnia is caused by a disease or external factors then you need to visit a doctor. In some diseases, taking a relatively harmless sleeping pill can provoke a worsening of the course of the pathology.

From tranquilizers to an elderly person, if there are no mental disorders and a pronounced sleep disturbance, it is better to refuse. They are addictive and depress the activity of the nervous system.

There are several groups of such drugs:

• synthetic;
• natural;
• homeopathic.

Synthetic

For the elderly, doctors are allowed 2 over-the-counter drugs:

Despite the relative safety of synthetic products, it is recommended to consult a doctor before using them.

natural

These include preparations consisting of herbal ingredients:

A good hypnotic effect is given by taking motherwort or valerian. They are produced in tablets or in tinctures and there are no contraindications for their use.

It is also worth saying a few words about Glycine. The drug does not contain plant materials, its active ingredient is aminoacetic acid, which is produced by the human body and regulates the processes of inhibition in the brain. The hypnotic effect of glycine has not been studied, it is prescribed to improve cerebral circulation after a stroke and with great mental stress (preparation for exams or for a responsible event), as well as with some neurological disorders. Aminoacetic acid regulates the imbalance between the processes of excitation and inhibition and improves the functioning of the nervous system.

homeopathic

In old age, sensitivity to drugs increases and some drugs are poorly tolerated by older people, so it is recommended to start the treatment of insomnia with lighter homeopathic remedies.

These drugs are well tolerated and do not side effects:

homeopathic remedies are considered the safest in the elderly and are used even for insomnia after a stroke. To improve the quality of a night's rest, it is recommended for old people to start with homeopathy, and then move on to stronger medicines.

Long-term use of sleeping pills causes memory impairment, headaches and impaired coordination in the elderly.

So to drink or not to drink drugs? Drink, but do not rely only on the action of medicines, you need to use others non-drug methods to combat sleep disorders.

Another recommendation: do not lie in bed trying to fall asleep. If you can’t fall asleep within half an hour, then you need to get up and do something: read or listen to calm music, and go to bed only when a feeling of drowsiness appears.

Psychologists also recommend one interesting psychological move based on the contradictions of human nature. Probably, everyone has a business that they don’t want to do, but they need to, for example. Clean up the paperwork or clean out the desk drawer with all sorts of little things folded there “just in case”. So, you need to mentally make a decision: “If I don’t fall asleep in 10 minutes, then I’ll go and finally sort out the papers,” as a rule, falling asleep after that happens quickly.

These tips will help you sleep better and have a good rest at night. Of course, at first you will have to use sleeping pills, especially if you have had insomnia for a long time, but gradually the body itself will begin to produce melatonin to ensure a good night's rest, and the drugs can be abandoned.

Effective and relatively harmless sleeping pills for an elderly person can be picked up without a prescription.

With their help:

But drugs with a hypnotic effect do not eliminate the cause of insomnia, and with prolonged use, they negatively affect the health of the elderly.

Older people often experience:

• decreased speed of thinking;
• memory disorders;
• lack of coordination;
• causeless headaches;
• weakness;
• increased fatigue;
• gastrointestinal disorders.

In addition, metabolism is significantly slowed down in old age, and the excretion of even relatively harmless plant components will slow down, which can cause their accumulation in the body and provoke undesirable consequences. More often people with kidney diseases and with respiratory pathologies (obstructive pulmonary disease, asthma) suffer from this.

The drugs may have good support an elderly person on initial stage treatment while lifestyle changes and development good habits and the rejection of harmful addictions (smoking, alcohol). Gradually, the dosage of sleeping pills is recommended to be reduced until there is a complete rejection of the drug without compromising the quality of night rest.

Over-the-counter sleeping pills for the elderly can be purchased at a pharmacy, but it is worth remembering that most elderly people have increased drug sensitivity and should be taken with great care.

Often seemingly harmless medicines cause exacerbations in older people chronic diseases, and to avoid unnecessary problems with health, it is recommended to consult a doctor about taking sleeping pills.

A person grows old: and he no longer sleeps like in his younger years ...

The amount of time needed for sleep varies from person to person. Some sleep more, others a little less.

It has been established that the peculiarity of human sleep is directly dependent on the state of the nervous system and the health of the whole organism as a whole. The human brain cannot be in excitation all the time, that is, without rest. This can cause brain cells to deplete nerve energy and even die.

Therefore, for the full-fledged work of nerve cells, for them to acquire a supply of nervous energy, it is necessary peace- change of excitation by braking. During sleep, inhibition processes predominate in the brain, oxygen consumption decreases, and accumulation of nutrients restores the body's energy.

Let's talk about sleep disorders in old age.

We must distinguish drowsiness and insomnia. Often older people are prone to drowsiness, sometimes they do not sleep enough.

With a systematic lack of sleep, a person naturally tends to sleep, but this is not yet a painful sleep disorder. In this case, the body's vital need for rest is simply not satisfied. It also happens that a person has slept enough, but woke up sluggish, in the morning he is not alert and not fresh. Such phenomena are observed when the body slowly moves from sleep to wakefulness, to vigorous activity. In these cases, it is recommended to do excitatory, tonic gymnastics after sleep.

Drowsiness It is also observed in people with a weak nervous system, which requires periodic shutdown of the body from a tense environment. In this case, drowsiness is a defense, a protection of the nervous system from exhaustion.

Another form of sleep disturbance is insomnia- It is very difficult for people to tolerate.

Insomnia is a sleep disorder when a person cannot fall asleep for a long time, and sometimes not at all. He tries to forget the impressions of the past day, lies with eyes closed, tossing and turning from side to side, and only in the morning falls asleep with great difficulty. Insomnia is a consequence of overwork or a strong nervous shock. But violate proper sleep and cause insomnia can even a hearty dinner or a large number of liquids drunk shortly before sleep (for example, strong tea, coffee) or taking drugs that excite the nervous system.

The cause of insomnia is either excessively strong excitation or weakening of the inhibitory process in the nerve cells of the cerebral cortex.

Insomnia manifests itself in different ways: there may be problems with falling asleep, sleep becomes superficial, restless, intermittent, early awakenings are frequent.

Sleep disorder

Sleep disturbance is the most common occurrence. Despite all the usual external conditions- late time, complete rest, comfortable bed, a person cannot fall asleep, although he wants to sleep. This state can last for many hours, falling asleep occurs long after midnight, and even in the morning, but short hours of sleep do not give rest, do not bring cheerfulness. Awakening in these cases is accompanied by a feeling of heaviness in the head, weakness throughout the body. In a person suffering from insomnia, working capacity is sharply reduced, fatigue from any work quickly sets in, quick wits and memory deteriorate.

Similar conditions occur with superficial, restless, intermittent sleep. Often, awakening in the middle of the night is accompanied by a strong heartbeat, difficulty breathing. Sometimes a dream is so superficial that a person, as it were, continues to take part in the life around him, he hears everything, understands everything and even reacts to surrounding events, wakes up easily, talks in his sleep. Frequent dreams. For the person himself, it remains unclear whether he was sleeping or just dozing. Naturally, this form of insomnia is also very debilitating.

Insomnia can occur in people whose profession is associated with frequent awakenings - among railway workers, on duty, night watchmen. Such people, even in a calm home environment, sleep very sensitively, alertly.

People who are accustomed to falling asleep in absolute silence, once in a new environment, sometimes lose their normal sleep. This happens, for example, when a person is on the road for a long time.

There are many "harmless" causes that affect the functioning of the nervous system, lead to certain sleep disorders, and change its depth. Any disturbing impression of a pleasant or unpleasant nature received by a person before sleep can disturb the depth of sleep. Many people fail to fall asleep quickly after intense mental work in the evening hours. Any anxious expectation, “fear of oversleeping” or “fear of falling asleep” can interfere with the timely onset of sleep.

How to deal with sleep disorders in old age?

People who suffer from insomnia often take various sleeping pills. At first, these remedies seem to help, but addiction quickly sets in, and they cease to have their healing effect.

I must say that the systematic use of sleeping pills is far from harmless to the human body, it can adversely affect the nervous system and, in turn, cause insomnia.

The longer the sleep disturbance continues, the harder it is to restore it. The main treatment for these disorders is strengthening the nervous system itself.

To achieve this, it is necessary to contribute to the maximum rest of the nervous system, in every possible way to protect it from additional loads and irritations. Medical measures should only be used under the supervision of a physician. Made great strides in the fight against insomnia modern medicine, relying on recent achievements technology. Methods currently widely used electrotherapy allow in many cases to do without sleeping pills, not indifferent to the body.

One of the most effective means in the fight against insomnia are calm environment and fresh air. In these conditions, any person falls asleep easier, and especially the elderly. You can sleep outdoors in the yard, in the garden, if there are conditions for this. good sleep at open window or window: the influx of oxygen calms the overexcited parts of the brain, and the person falls asleep quickly.

If the room is cool, then a woman should cover her head with a linen scarf, and an elderly man will need a linen cap for this purpose.

You should sleep in cotton linen and cover yourself with a linen sheet, and on top - with a woolen blanket.

The bed should be comfortable, the linen should be fresh, and the pillows should not be too high.

Very useful take a walk outside before bed. It always improves sleep.

To sleep was normal, you must always go to bed at the same time. What is it for? If a person has a clear daily routine, rests in a timely manner and always goes to bed at the same hour, his whole body adapts to this regimen. At a certain time, such a person has an appetite, the digestion process proceeds fully. At the hour when a person is used to getting ready for bed, he already wants to sleep, he falls asleep quickly and soundly.

It is desirable that no stimuli interfere with sleep - external ( bright light, sounds of the radio, various noises, heat or cold in the room) or internal (a full stomach, pain in the joints, in the heart, toothache). All this can disturb sleep, make it superficial, restless, full of heavy dreams.

With a reasonable attitude towards their health, every elderly person will be able to establish a healthy, deep sleep.

Anna Novikova, candidate of biological sciences.

Folk remedies for insomnia

With nervous insomnia, mental work, any vigorous activity should be avoided in the evenings, you should have an early and light supper and go to bed early.

It is useful to take a warm bath before going to bed or make a hot foot bath. Also helps general massage before going to bed, and in bed to the feet it is good to put a heating pad.

FOLK REMEDIES. Drink a glass of hot sweet water, hot milk or hot infusion at night valerian root. Pour a teaspoon of the root with a glass of boiling water, leave for twenty minutes, strain.

Stuff your pillow with fresh cones hops. Success is guaranteed even with severe insomnia.

Before going to bed, it is useful to take a walk in the fresh air for at least half an hour.

You can use a sleeping pill from the seeds dill, boiled in Cahors or port wine: 50 g of seeds are boiled for 5-10 minutes over low heat in 1/2 liter of wine. Before going to bed, take 50-60 g.

If you drink three teaspoons of decoction at night poppy(one head per half liter of water), this will ensure a sound sleep without harming the body.

tablespoon honey drink with a glass of water an hour before bedtime.

It is good to sniff valerian drops before going to bed.

Lubricate whiskey before going to bed lavender oil. It is good to suck a piece of sugar with 3-5 drops of lavender before going to bed.

If these simple remedies do not help, you can sew all the bedding from black material, paint the walls of the bedroom with black paint (but not oil). This gives amazing results: even people who have been suffering from persistent insomnia for months fall asleep peacefully.

To save memory, you should stick to a sleep schedule

Sleep patterns in middle and old age are directly related to the quality of memory. According to the staff of the Bergamo Women's Hospital, when a person sleeps very much or very little, this will definitely have a negative impact on memory in the future, writes Business Standard. So, women who slept 5 hours or less or 9 hours or more per day had memory impairment equivalent to two years of brain aging. Ideal sleep pattern - 7 hours a day. If the duration of sleep changes over time by more than two hours, this will also damage memory. Scientists advise not to change the duration of sleep throughout life, to constantly adhere to one selected mode in order to protect yourself from cognitive impairment. Previously, employees of the American Academy of Sleep Medicine found that extra hours of sleep provoke the development of diabetes, heart disease, anxiety and obesity. Getting the right amount of sleep reduces the risk of these diseases and improves the health of people over 45, scientists say.

What can I do to fall asleep easily every night and wake up fresh and rested in the morning?

A person wakes up a third of his life. It may seem to some that this is too much. But we must sleep a certain amount of time, otherwise our body may suffer. To find out the importance of sleep for a person, experiments were conducted when volunteers were asked not to sleep for as long as possible. On the 5th-8th day, all participants had worsened vision and hearing, impaired coordination of movements, some had hallucinations. The experiment had to be stopped. But he proved the need for sleep for our body.

“If a person is supposed to have a regime of alternating wakefulness and sleep, then such a regime should be. If a person artificially tries not to sleep, the central nervous system is depleted, ”- says the narcologist, head of the department intensive care Dnepropetrovsk Regional Narcological Dispensary Svetlana Bogatikova.

The sleep of an adult should be 6-8 hours daily. This time is enough to accumulate the necessary amount of energy we need during the day. If there is a systematic lack of sleep, this can lead to health problems.

Sleep problems with age

In young age dream comes easily. Often it is enough just to touch the head to the pillow, as we find ourselves in the realm of Morpheus. But with age, many people have problems with sleep:

• it becomes harder to sleep
• the quality of sleep worsens: sleep becomes too sensitive and superficial, nightmares occur
• awakening too early, it is impossible to “sleep”
• no feeling of rest after sleep
• insomnia appears

Older people need to get enough sleep!

Sleep is important for people of all ages, but getting enough sleep is especially important for older people:

• Many regeneration processes take place during sleep. in the body, and with age it is especially important that they work to their full potential.
• Sleep restores the immune systemsystem. Lack of sleep weakens our immunity, which can lead to various diseases.
• Healthy sleep helps maintain normal body weight. People who sleep less than they should have increased cravings for overeating. Moreover, those who do not get enough sleep are more often drawn to cookies, sweets and cakes than to vegetables and fruits. This happens because with insufficient sleep (4-5 hours), the level of the hormone ghrelin rises in the blood. This hormone increases the feeling of hunger. And with a strong feeling of hunger, a person is drawn to eat more simple carbohydrates. Numerous studies have shown that with a lack of sleep, the likelihood of earning overweight is doubled. BUT excess weight for the elderly - this is a powerful factor that provokes the development of many diseases.
• Sleep normalizes blood pressure. Many older people are prone to hypertension. Lack of sleep causes an increase in blood pressure.
• Sleep helps to get rid of unnecessary worries, forget stressful situations, streamline thoughts.

Statistics say that the older a person is, the more likely it is that he will have sleep problems. But this can be avoided. You just need to try a little and take control of your sleep.

For healthy sleep in old age

• Go to bed tonight. Not only the amount of sleep is important, but also the time you go to bed. It is better to go to bed at 10-11 o'clock. Sleep in the evening is very important for normal recovery forces.
• Don't go to bed if you're not drowsy. Going to bed at 10 pm is good. But if you do not want to sleep at all at this time, you do not need to force yourself. Instead of tossing and turning in bed for a long time and thinking about insomnia, it is better to do some useful, calm business. And when the first signs of drowsiness appear, immediately go to bed.
• Go to bed and wake up at the same time. Try to get your body used to the routine. Then the “shutdown” and awakening will come faster and easier.
• Make time for physical activity during the day.Physical activity morning and afternoon will help you sleep better in the evening. Those. in order for the body to “want” to fall asleep in the evening, you need to work your muscles and spend energy during the day.
• Physical activity immediately before bedtime is contraindicated. You need to prepare for bed in advance. In order for the body to tune in to sleep, it is necessary to avoid active action for several hours before bed. A walk in the fresh air helps to fall asleep well. But you need to walk a few hours before bedtime so that the body has time to adjust to the "sleepy" mode.
• Do not overeat before bed and do not drink invigorating drinks. The last meal should be 3-4 hours before bedtime. Then the active work of the stomach will not interfere with falling asleep.
• Find a quiet activity before bed. You should not watch action movies or melodramas, gamble, discuss politics or make plans for tomorrow right before bed.
• Provide silence. As people age, they become more sensitive to sounds. And any noise can interfere with sleep. Try to isolate yourself from annoying sounds.

Often cause of sleep problems is an hidden depression old people. But age is not a reason for gloomy moods. Don't let depression take over. Be positive, enjoy life and let healthy sleep give you a boost of energy at any age!

As people get older, they often experience changes in their sleep patterns – desire to fall asleep earlier, wake up earlier, sleep less deeply.

However, sleep problems, daytime sleepiness and other symptoms of insomnia are not a normal part of aging.

Sleep is important for our physical and emotional health. Certain tips regarding insomnia in the elderly can help in its treatment and in overcoming age-related sleep problems.

As we age, our bodies produce less and less growth hormone.

Decreases in melatonin make sleep more fragmented, causing more frequent waking during the night. In most cases, these changes are normal and do not indicate a sleep problem.

Although sleep needs vary among different people, most adults need 7.5 to 9 hours of sleep per day. At the same time, proper sleep is much more important than a certain number of hours spent in bed.

Frequent awakenings at night and feeling tired during the day clear signs insufficient quality of sleep, not letting you feel rested. However, many cases of insomnia are due to causes that can be corrected.

Causes of insomnia and sleep problems in the elderly include:

• "Bad" habits associated with sleep. They include an indefinite sleep schedule, TV on, noise, and drinking before bed. It is important to create a comfortable, dark, quiet environment around you and follow certain rituals to help you fall asleep.
• Health problems. Frequent urination, pain, arthritis, asthma, diabetes, osteoporosis, nocturnal heartburn, Alzheimer's disease are causes that interfere with sleep. In this case, it is necessary to consult a doctor to solve problems associated with a particular disease.
• Menopause and postmenopause. During menopause, hot flashes and night sweats can often interrupt sleep. Sleep problems can continue after menopause. In this case, diet and exercise help.
• Medicines. Older people often take a large amount of medication. Side effects from taking them can make you feel worse. Your doctor may adjust your medications to improve your condition.
• Lack of exercise. If a person leads a not too mobile life, the severity of his sleep-wake cycles decreases. Falling asleep may worsen and vice versa, there will be a desire to sleep in daytime. Regular aerobic exercise throughout the day can help promote good sleep.
• Stress, depression, chronic anxiety and restlessness. Significant life changes such as death loved one or moving can be stressful. In this case, nothing improves mood better than an interlocutor with whom you can talk on various topics.
• Lack of social activity. Social activity, family and work keep you active and prepare your body for a good night's sleep. If a person is retired, you can sign up for community groups or take up your education.
• Sleep disorders. Syndrome restless legs or sleep breathing disorders (such as snoring or sleep apnea) are more common in older people. In this case, you need to consult a doctor to solve the problems that arise.
• Absence sunlight. Bright sunlight helps regulate melatonin and human sleep-wake cycles. Get at least two hours of sunlight per day. It is important to keep your window shades open during the day, or you can purchase a home light therapy device.

And in the next article, you can read an overview of drugs for insomnia, on this one.

Methods for the treatment of sleep disorders

Methods include medical assessment of the causes of the disease and teaching patients about good sleep hygiene.

If necessary, drug therapy is applied.

The patient is assessed for:

• negative effects of drugs on sleep;
• assessment of primary sleep disorders (eg, snoring, sleep apnea);
• the presence of basic medical, psychiatric and drug addiction disorders and diseases.

Consulting a doctor can help in assessing the presence of medical (including mental) causes of insomnia. The evaluation is usually done by a neurologist, psychiatrist, pulmonologist, sleep medicine specialist, and nutritionist.

Can be shown surgery insomnia to correct diseases that cause insomnia: palate surgery for snoring, surgery for some cases of sleep apnea.

How to beat insomnia

In most cases, sleep hygiene advice can help improve sleep in older adults.

Tips include addressing emotional issues, improving sleep patterns, and choosing healthier daytime habits.

Because everyone is different, some experimentation may be needed to find changes:

• Improving night sleep, aimed at increasing the level of melatonin in the body. artificial lighting at night, it can suppress the production of melatonin, a hormone that increases the desire to sleep. It is better to use low-power night lights and turn off the TV at at least an hour before bed.
• It is important not to read or watch TV in low light in the evening. It is better to use additional light sources.
• You need to make sure that the bedroom is quiet, dark, cool and the bed is comfortable enough. Noise, light, and excess heat can cause sleep problems. You can use a sleep mask to reduce the amount of light entering your eyes at night.
• It is advisable not to use the bedroom for homework and watching TV, especially in bed, so that the brain associates the bedroom only with sleep.
• If the clock interferes in the bedroom, it is better to remove it from the room, as the light and sound of the clock can affect the condition.
• You need to maintain a consistent sleep schedule, going to bed and waking up at the same time every day, even on weekends.
• Go to bed on time. It is important to determine when you want to sleep and go to bed at this time, even if it is earlier hours.
• Snoring blocking. If snoring interferes with sleep, you can use ear plugs or sleep in a separate bedroom from the snorers.
• It's important to develop calming rituals before bed - taking a bath, listening to music, or using relaxation techniques such as meditation or deep breathing to help you unwind.
• Physical closeness, such as cuddling between partners, helps with restful sleep.
• Restriction in taking sleeping pills. Many sleeping pills have side effects and are not intended for long-term use. Sleeping pills do not eliminate the causes of insomnia and may even make it worse.
• Sleeping during the day can provide energy for the rest of the day. You can try sleeping during the day to see if it helps you sleep better at night.

Insomnia medications for the elderly

Medications are needed when all non-pharmacological treatment options for insomnia are used.

Indications for treatment include:

• barbiturates (Pentobarbital, Phenobarbital, etc.);
• benzodiazepines (Doral, Triazolam (lithium), Temazepam, etc.);
• antihistamines (Tylenol, etc.).

Barbiturates are rarely used in the treatment of insomnia in the elderly. they provoke addiction and have many side effects - agitation, confusion, nightmares, nervousness, etc.

Benzodiazepines are also quite dangerous in the elderly due to the risk of serious complications - severe sedation, weakness, dizziness, disorientation, headache, sleep disturbances, etc.

Antihistamines are often used to treat insomnia in the elderly. However, the Diphenhydramine (Benadryl) included in these preparations does not allow them to be used widely enough.

Treatment of insomnia in the elderly folk remedies

• Honey. This is probably probably the best "drug" in the treatment of insomnia, it is very effective and absolutely harmless.
• Honey with yogurt: 1 tbsp honey stir in 1 glass of yogurt. Drink at night for 7 days. Take 25-50 grams of honey in the morning and evening along with 1 tsp. royal jelly.
• Fees for insomnia. Grind the peel (zest) of one lemon with 3 tbsp. chamomile flower baskets, 2 tbsp. valerian roots and pour 1 cup hot water, leaving to infuse for 1 hour. Strain, cool and take 0.5 cup twice a day in the morning and after dinner.
• Herbs for the treatment of disease. Finely grind 2 tbsp. blood-red hawthorn fruit. Pour 1.5 cups of boiling water over them and drink in 3 divided doses half an hour before meals. This recipe is also good for people with heart conditions.

In the fight against insomnia, you can visit the steam room and use oak brooms - this calms you well and helps you fall asleep.

Conclusion

Insomnia and chronic use sedatives are common cause accidents, decreased productivity, increased morbidity and mortality among affected people.

Chronic insomnia usually includes many various factors and its treatment should focus on identifying and treating the underlying problems associated with insomnia, determining the exact doses of medications taken, and efforts towards non-drug therapies that should be the main line of therapy.

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For citation: Mikhailova N.M. Sleep disorders in the elderly and senile age. Clinical guidelines for treatment // RMJ. 2003. No. 28. C. 1610

State Research Center for Mental Health of the Russian Academy of Medical Sciences, Moscow

P The problem of sleep disorders in the elderly has been neglected for a long time, despite the increase in complaints about bad dream and increased consumption of sleeping pills. According to a number of epidemiological studies of the population of older age groups(65 years and older), up to 35% of the elderly and the elderly have problems with sleep. Sleep dissatisfaction is noted in 25% of men and 50% of older women. More than 25% of patients late age regularly or frequently use sleeping pills. Sleep disturbance is one of the factors in assessing the quality of life of the elderly.

The main manifestations of sleep disorders in the elderly:

Persistent complaints of insomnia;

Constant difficulty falling asleep;

Superficial and interrupted sleep;

The presence of vivid, multiple dreams, often painful content;

Early awakenings;

Feeling anxious on waking;

Difficulty or inability to fall asleep again;

No feeling of rest from sleep.

Elderly patients with dyssomnic disorders awaken more often during the first hours of sleep, are more anxious, tend to exaggerate the duration of the falling asleep period and underestimate the duration of sleep.

The main causes of sleep disorders in the elderly and the elderly

At a later age, the multifactorial nature of sleep disorders is most often recognized, the interaction of psychosocial, medical and psychogenic factors in combination with organic brain dysfunction. However, modern taxonomy of sleep disorders provides for their division into primary and secondary.

To primary sleep disorders in the elderly include nocturnal myoclonus, nocturnal leg restlessness, and sleep apnea(with holding the breath during sleep and subsequent awakening). It should be noted that sleep apnea is generally more characteristic of later age or becomes more frequent with age. This is usually preceded by a long period of snoring during sleep, and then apnea joins. It is well known that this syndrome occurs predominantly in obese men in the second half of life, but often occurs in women in old age.

Secondary sleep disorders caused by somatic diseases, neurological lesions, mental disorders, in which dyssomnic disorders are a symptom of these diseases. Most often it is a cardiovascular pathology (hypertension, coronary heart disease), when there is nocturnal arterial hypertension, nocturnal angina attacks. Often, sleep disorders occur in patients with heart failure with inadequate therapy for this condition, and correction therapeutic tactics heart failure allows you to regulate and sleep disturbances. Sleep disturbance can be caused by an increase in nocturnal asthma attacks or exacerbations of chronic obstructive pulmonary disease, various pain syndromes, in the elderly and senile age most often with polyosteoarthrosis. Sleep disturbances can be a symptom endocrine pathology(thyrotoxicosis, diabetes). Intermittent sleep due to nocturia in patients with benign prostatic hyperplasia. Restless legs syndrome, accompanied by a violation of falling asleep, may be secondary (B 12 deficiency anemia, chronic kidney failure, diabetic polyneuropathy, etc.). Prior to falling asleep, painful sensations in the legs and feet make patients move their legs or walk, resume when they go to bed and disappear only in a sufficiently deep sleep. For sleep disorders associated with somatic pathology, the most characteristic are superficial sleep and frequent awakenings rather than difficulty falling asleep. In these situations, it is of paramount importance adequate therapy the underlying disease, and the use of drugs with a hypnotic effect is justified only if unsuccessful measures taken and taking into account strict contraindications to the appointment of psychotropic drugs.

In neurological practice, sleep disorders have been studied in detail in organic CNS lesions involving structures that provide the initiation and maintenance of sleep, lesions of the peripheral nervous system (in vertebrogenic diseases, polyneuropathies, etc.), as well as in neurogenic asthenic conditions.

Among all secondary sleep disorders in later life, two-thirds are mental disorders and diseases . The most common symptom of sleep disorders depressive states various genesis, both endogenous and neurotic, vascular. At the same time, even shallow depressions (mild and moderate degree severity), as a rule, are accompanied by dyssomnia. There are depressions in which sleep disorder is the leading one and determines clinical picture state, while actually depressive symptoms revealed only by careful questioning. Minor depressions are especially common in somatic practice, but not always diagnosed, often due to masking depressive disorders somatic complaints and symptoms or other manifestations of atypia.

Depressed patients with sleep disorders often complain of insomnia. During questioning, both difficulties in falling asleep and characteristic early awakenings with the inability to fall asleep again are revealed, anxiety on awakening at night, a painful state of mind in the early morning hours. It is depressive patients who are characterized by the lack of a sense of sleep, often formed obsessive fear before nightfall and insomnia.

Among psychiatric situations with sleep disorders, there may be states when patients do not complain, however, there are pronounced sleep disorders (states of excitation in psychosis, manic or hypomanic states, delirious disorders of toxic and vascular origin), as well as in dementia of late age. In the latter case, sleep inversion is often observed with nocturnal fussy wakefulness and daytime sleepiness. Such a clinical situation is especially difficult both in a hospital setting and in home care for dementia patients.

In geriatric practice, it is especially important to consider the possibility iatrogenic insomnia . According to the direct pharmacological mechanism, sleep disorders can be caused by the following drugs:

Psychotropic drugs (antidepressants, psychostimulants, nootropics);

Antihypertensive drugs (clonidine, b-blockers);

antiarrhythmic drugs;

Bronchodilators (ipratropium bromide, terbutaline, salbutamol, theophylline preparations);

Hormonal drugs (glucocorticoids, thyroid hormones, progesterone);

Some antibiotics (quinolones);

Lipid-lowering agents (statins, fibrates, cholestyramine);

Antiparkinsonian drugs (levodopa, selegiline);

Cardiac glycosides (with their overdose);

Anticancer drugs;

Antitussives.

Sleep disturbances can cause eye drops containing b-blockers, and nasal drops containing sympathomimetics. Due to indirect pharmacological mechanism sleep disturbances may occur when taking diuretics (including due to fear of incontinence), antidiabetic drugs (polyuria, hypoglycemia, etc.).

Identification of the main cause of insomnia, as well as clarification of the features of sleep disturbance according to the main parameters (falling asleep time, sleep duration, night awakenings, the presence and nature of dreams, assessing the quality of sleep and the quality of awakening) is necessary not only in diagnostic purposes but also important for the choice of methods and means of therapy.

Basic principles of management of elderly patients with insomnia:

Identification of the cause of insomnia with possible correction;

Medical therapy.

The first task of the doctor is the differential diagnosis of sleep disorders in elderly and old age clarification of the main manifestations of dyssomnia and only after that the adoption of therapeutic intervention measures.

Patient education suffering from insomnia comes down to the following recommendations:

The need to go to bed only when the need for sleep occurs;

Moving from bedroom to another reading room when unable to sleep after 15-20 minutes in bed and returning to bedroom when needing to sleep again. The purpose of this maneuver is to associate the bedroom with sleep, and not with insomnia;

Getting up in the morning from bed at the same time, regardless of the duration of sleep last night;

Avoiding daytime sleep or minimizing it (no more than 30 minutes if you need to sleep);

Restriction of stay in bed only during sleep;

Going to bed at the same time, avoiding excessive impressions in the evening, overeating, tonic drinks, etc.

Basic principles drug therapy insomnia:

Having indications for drug therapy insomnia;

Appointment of low effective doses;

Selection of a drug with optimal pharmacokinetic properties;

Intermittent therapy (2-3 times a week);

Short-term use of drugs (3-4 weeks);

Gradual withdrawal of hypnotics;

Monitoring of patients during treatment and after discontinuation of the hypnotic.

Only conditions with a long-term sleep disturbance are subject to drug treatment. Transient episodes of dyssomnia do not require medication, as well as physiological changes sleep patterns in the elderly and elderly.

Primary sleep disorders require a differentiated approach to treatment. While tranquilizers can be helpful for myoclonus, these drugs are not indicated for sleep apnea, as they can aggravate breathing problems. Some effect is achieved with the appointment of cyclopyrolones (zopiclone, zolpidem).

The basic principles of therapeutic correction of secondary sleep disorders are reduced to active and adequate treatment of the underlying disease (somatic, neurological mental) whose symptom is sleep disturbance, correction of drug therapy for iatrogenic dyssomnias.

If earlier, for the treatment of depressive disorders, combined therapy with antidepressants and tranquilizers, including hypnotics, was traditionally used, now the latest antidepressants (mirtazapine, mianserin) have been introduced into practice, which have the properties of improving sleep and do not require additional prescription of tranquilizers-hypnotics.

In cases of iatrogenic dyssomnia, of course, it is necessary to reconsider the doses of drugs used that are potentially responsible for sleep disturbance; it is useful to maneuver the regimen of taking drugs during the day, etc., that is, it is desirable to do everything possible to do without additional prescriptions of psychotropic drugs.

When prescribing tranquilizers to the elderly, including those with a hypnotic effect, the doses of the drugs should be halved compared to those used in young and middle age, and the courses of therapy should not exceed the required duration, be interrupted in a timely manner when the effect is achieved, or be replaced by taking medications in a non-permanent mode.

The choice of drug for the treatment of sleep disorders

For the medical treatment of sleep disorders in elderly and senile patients, first-generation hypnotics (i.e. barbiturates) are currently avoided due to high risk respiratory depression during sleep.

Most wide application in the treatment of secondary sleep disorders, benzodiazepine derivatives or second-generation hypnotics are found . When prescribing them, one should proceed from the prevailing features of sleep disorders and information about the pharmacokinetic properties of drugs, first of all, about their half-life from the body. Depending on this, drugs are divided into three groups:

Preparations short action(up to 6 hours);

Preparations of medium duration of action (up to 12 hours);

Long-acting drugs (more than 12 hours).

Short-acting drugs (midazolam, triazolam, flurazepam) are prescribed for severe difficulty falling asleep. Often, to facilitate falling asleep, tranquilizers without hypnotic action (oxazepam, tofisopam, temazepam, diazepam) are used, which relieve the feeling of internal tension and mild anxiety, thereby facilitating falling asleep due to the sedative effect. Without leaving drowsiness, they can still cause daytime muscle relaxation.

Intermediate-acting benzodiazepine hypnotics (bromodihydrochlorophenyl benzodiazepine, temazepam) are indicated to improve falling asleep, achieve greater depth of sleep, and eliminate frequent nocturnal awakenings. Trace reactions after taking them are not uncommon in the form of morning drowsiness, muscle relaxation.

benzodiazepine drugs with long period elimination half-lives are used in patients with sleep disorders, superficial sleep and early awakenings. These drugs significantly improve sleep characteristics, but are most likely to leave traces of drowsiness during the day, thus increasing the risk of adverse effects with long-term use.

In geriatric practice, when prescribing benzodiazepine drugs, patients with sleep disorders have to maneuver between the effectiveness of longer-acting drugs with the risk of their accumulation in the senile body and safer drugs in this respect with a short half-life, but with a significantly higher incidence of sleep disorders when they are discontinued. Tactically medical techniques also include switching drugs, intermittent dosing, dose reduction.

Benzodiazepines drug interactions

Given the forced polypharmacy in elderly patients with multiple somatic pathologies, the problem inevitably arises. drug interaction, in particular, the interaction of benzodiazepine drugs with other drugs when they are combined with the elderly and the elderly:

Strengthening the hypotensive effect of clonidine, ACE inhibitors;

The risk of increasing blood pressure with the simultaneous administration of theophylline drugs;

The inhibitory effect on the central nervous system when combined with b-blockers;

An increase in the concentration of a tranquilizer (midazolam) in serum when combined with calcium channel blockers;

An increase in the concentration of cardiac glycosides in serum;

When combined with cimetidine, omeprazole, the concentration of benzodiazepines in serum increases;

When taking anticoagulants (warfarin), there is sometimes an increase in prothrombin time;

Increased hypoglycemic effect simultaneous application with antidiabetic drugs;

Macrolides slow down the metabolism of alprazolam, on the contrary, rifampicin, according to some reports, has the ability to accelerate the metabolism of diazepam. Isoniazid inhibits the metabolism of diazepam.

Side effects of benzodiazepines

As for the problem of side effects of the treatment of sleep disorders with benzodiazepine derivatives, such as muscle relaxation and trace drowsiness are well known to doctors (the main contraindication is usually not missed - the diagnosis of myasthenia gravis or myasthenic syndrome). As experience shows, the appearance of undesirable effects makes the patients themselves, with preserved criticism, refuse to take drugs, reduce the dose, reduce the intake or resort to alternative methods treatment of sleep disorders. Less awareness among doctors general practice usually there is a moderate inhibitory effect on the respiratory center, especially in chronic obstructive pulmonary disease, the possibility of constipation when taking clonazepam, bromdihydrochlorophenyl benzodiazepine. It should also be borne in mind the possibility of reducing the contractile function of the myocardium, mild arterial hypotension.

Undesirable consequences of the use of tranquilizers-hypnotics in elderly and senile patients:

excessive sedation;

Muscle relaxation;

Balance disorders, falls;

Disorders of concentration of attention;

Aggravation of dysmnestic disorders.

In general, the use of benzodiazepines for sleep disorders in the elderly and elderly is quite safe, and this is well known to practitioners.

drug addiction

A natural concern for both doctors and patients themselves is the problem of drug dependence. Far from ignoring this problem, it should be recognized that in their expressed clinical manifestations, that is, with the development of mental and physical dependence, signs of increasing tolerance, the need to increase the dose and severe manifestations of the withdrawal syndrome, this is extremely rare in the elderly and the elderly. The risk of dependence is increased if there is a history of addiction to alcohol or persisting into old age. Usually we are talking about concerns associated with long-term or continuous use of the same dose once before bedtime. Clinical observations show that in relation to these cases it is not entirely legitimate to use the concept of substance abuse. Guided by the principles of course treatment of limited duration, in some cases it can be recognized as sufficiently safe and long-term use of drugs in order to improve the quality of life of elderly patients.

Hypnotics of the new generation

In recent years, the possibilities of effective and safe treatment of sleep disorders in elderly and senile patients have significantly expanded due to the development and introduction into practice of third-generation hypnotics, which include cyclopyrrolone derivatives (zopiclone, zolpidem). These drugs show significant advantages both in the manifestations of a hypnotic effect, and in the almost complete absence negative consequences therapy, as well as in the features of the application. Due to the higher selectivity of the effect on benzodiazepine receptors medications This group provides sleep that is closest to physiological. The hypnotic effect occurs soon due to the rapid absorption of drugs, and therefore it is recommended to take medication before bedtime, already lying in bed. short period The half-life of hypnotics of this series makes them indicated primarily for sleep disturbances. On the other hand, these pharmacokinetic features prevent the accumulation of the active agent and its metabolites in the body of elderly patients, which has a positive effect on tolerability and the absence of an aftereffect of sleeping pills the next day. The only frequently observed unwanted effect found in complaints of bitterness in the mouth, which dictates the need to reduce the dose from 1 tablet (7.5 mg) to 1/2 tablet. A special study of the dynamics of the state of cognitive functions did not reveal signs of their deterioration (according to the MMSE scale) with monthly duration course of treatment. Upon reaching therapeutic effect there are no significant problems with the end of therapy. At present, drugs of this group (zopiclone, zolpidem) are considered as first choice drugs for the treatment of sleep disorders of various origins in geriatric patients.

The effect of tranquilizers on the cognitive functions of the elderly

In geriatric practice, another question arises, namely, the effect of taking tranquilizers, including those with a hypnotic effect, on the cognitive functions of aging patients. It is known that these drugs can reduce the concentration of attention, and according to some reports, and affect the mnestic abilities, weakening them. The risk of developing cognitive decline is more relevant with long-term use of tranquilizers taken repeatedly during the day and, as experience shows, is hardly justified when taking minimal doses of these drugs before bedtime. However, if there are signs of cognitive decline with attention concentration disorders and mnestic disorders, the appointment of tranquilizers, even only for the purpose of improving sleep, should be strictly limited both in time and in the dose used, especially since in the elderly and old people with dementing diseases and sleep disorders this is not brings the desired effect.

Quite often practiced is the appointment of amitriptyline to elderly patients with complaints of insomnia, taking into account side effect this drug in the form of drowsiness, as well as its anti-anxiety properties. However, as practice shows, this rarely takes into account contraindications to taking amitriptyline (glaucoma, benign prostatic hyperplasia, cardiac pathology with rhythm disturbance) and does not take into account the anticholinergic effect at long-term use with the risk of aggravating cognitive disorders in the elderly and elderly with disabilities. memory.

Sleep disorders in patients with dementia

Special therapeutic approaches require sleep disorders in patients with dementia of late age (Alzheimer's type, vascular, combined vascular and atrophic), as well as sleep disorders in the clinic of delirium disorders, most often of vascular origin. In these cases, dementia patients almost never complain of insomnia themselves. Patients with cerebrovascular disease often report unusually vivid dreams of painful or fantastic content. It should be borne in mind that these manifestations may be a prodrome of vascular delirium, and timely correction of drug therapy can prevent the development of confusion.

In dementia patients, sleep disorders are caused by circadian rhythm disturbance in the form of sleep inversion with wakefulness at night and drowsiness during the day . As a rule, these states are accompanied by disorientation, restless behavior, fussiness, "packing for the road", knitting knots from bed linen, removing things from wardrobes, etc. that is, manifestations of behavioral disorders characteristic of dementia of late age. In delirious states of vascular genesis, mental disorders increase in the evening, confusion occurs or intensifies at night, patients do not sleep, are motorized, and often experience deceptions of perception (illusions, hallucinations). These states with severe violations sleep makes management of patients in a hospital (as well as care at home) extremely difficult and is often the cause of stress disorders in relatives of dementia patients and staff in care departments. The use of tranquilizer-hypnotics and third-generation hypnotics is generally ineffective in patients with dementia or confusion. Moreover, a paradoxical effect with increased excitation during their use is well known. In these cases, treatment with small doses of neuroleptics is most justified. Best effect and the safety of use is ensured with the appointment of modern drugs from the group of atypical antipsychotics (risperidone 0.5-1 mg, quetiapine 25-100 mg, olanzapine 2.5-5 mg). In the absence of the possibility of their acquisition, haloperidol drops (up to 5-10 drops), periciazine drops (3-5 drops), thioridazine 25-50 mg at bedtime are used with sufficient effect. However, these appointments are only a temporary addition to the main neurotransmitter or vasoactive therapy.