Home health care provides a caregiver the opportunity to monitor and treat poor sleeping cycles in the elderly
Elderly patients are especially vulnerable to insomnia: sleep cycle changes, medical and emotional disorders, and multiple medications are a few factors contributing to sleep disruption in elderly patients.
Insomnia occurs more frequently in persons over the age of 60 who sleep an average of 6.5 hours compared to the eight that most adults sleep. Changes in the sleep cycle that occur with age are one cause. Disturbed sleep also may be a symptom that reflects a serious underlying medical problem; or it may accompany physical and emotional abnormalities that are correctable or that subside with time.
Generally, elderly persons have sleep that is less restful and not as deep as it was when they were younger. Their first sleep cycle is shorter than that of children and young adults, and they have more stage 2, and less of stages 3 and 4 sleep. Sleep progresses in four deepening stages, plus rapid eye movement (REM) sleep. Stage 1 is a transitional “drowsy” phase that precedes deeper, more restorative stages. Stage 3 and 4 are called Delta sleep and are the deepest and most refreshing parts of sleep. Stage 1, the lightest sleep, increases with age.
One must first assess if the insomnia is short (less than 3 weeks) or long-term (more than 3 weeks). Long term is often referred to as chronic insomnia. It may be caused by alcohol and substance abuse, depression anxiety, chronic pain, along with many medical disorders. Anxiety is the most common cause of insomnia and results in difficulty falling asleep. Depression, on the other hand, usually manifests itself in early awakening. Some of the medical causes could be congestive heart failure, hyperthyroidism, rheumatologic diseases, dementia, Parkinson’s disease, asthma and others. The good news is that most of these problems can be treated resulting in the alleviation of the insomnia.
Home health care is a growing segment of medical care for the elderly and provides the caregiver a window into the sleep and living habits of an individual who may not realize that he is able to improve his quality of sleep. Home health care providers see a patient in his own living environment and are able to view his activities of daily living along with his diet, all of which may hamper sleep patterns. It is the duty of the home care nurse to address harmful habits and educate the patient on improvements that could minimize the patient’s sleep problems. Nurses who administer medication are able to anticipate problems with sleep and relay that concern to other home health aides who may be present during the evening/night when insomnia occurs.
The cornerstone of insomnia management, however, is the use of natural remedies. This includes establishment of a bed time routine, and instructing the patient to avoid napping and to engage in exercise. Diet restrictions such as caffeine alcohol and smoking should be avoided. Stress therapy may be helpful, too. Many herbal remedies are available, such as valerian root, chamomile and melatonin but they remain unproven in most medical circles. There are a host of medications with sedative qualities that are used to treat various types of insomnia. But one must remember that medications often have side effects and are only recommended for short periods of time. By coordinating medication, exercise and nutrition, the home heath care nurse can achieve a balance that will optimize their patient’s sleep.