How much sleep do you need to get enough sleep, and why older people get up earlier than everyone else.
We talked about how to improve sleep hygiene and what chronic lack of sleep leads to in the first part of the interview with Oksana Vladilenovna Belan , a psychotherapist at the medical rehabilitation department of the Republican Clinical Medical Center. Continuing the topic, we will touch upon the issues of sleep disorders in older people. Insomnia and decreased mood are often mistaken for the first sign of senile dementia.
Causes of sleep disorders in the elderly
In older people, the duration of slow-wave sleep decreases or disappears altogether. The structure of sleep in older people can be compared with the sleep of young children. An older person is prone to dozing during the day and waking up at night. Another cause of insomnia is a decrease in the production of the sleep hormone melatonin, which is controlled by the pineal gland (epiphysis) in the brain.
Often the cause of insomnia in older people is concomitant pathologies:
- cerebrovascular accident;
- arterial hypertension;
- diseases of the digestive system;
- urinary disorders;
- pain syndrome;
- respiratory and heart failure;
- mental diseases Alzheimer's, Parkinson's, dementia.
Common reasons include:
- sleep apnea;
- restless legs syndrome;
- endocrine disorders;
- taking psychoactive substances: alcohol, caffeine.
Medications can also cause sleep disturbances. Such medications include:
- hypotensive;
- psychotropic;
- bronchodilators;
- antiarrhythmic;
- statins;
- hormonal;
- glycosides;
- antitumor;
- antiparkinsonian;
- narcotic analgesics.
If long-term insomnia negatively affects your health, you cannot do without medications for insomnia in old age and adequate treatment of the underlying disease.
Diagnosis of insomnia
Our clinic offers a comprehensive examination to identify the causes of insomnia. Our doctors usually conduct an initial medical examination to identify a specific predisposition. To determine the most accurate diagnosis, we examine the patient using hardware diagnostics:
- We do a cardiogram;
- We perform an ultrasound;
- We examine the patient’s condition using magnetic resonance imaging;
- We carry out detailed and general blood tests and other laboratory tests.
When participating in a conversation with a doctor, try to remember all the details as accurately and in detail as possible in order to give the most comprehensive answers to the doctor’s questions. A correct diagnosis will allow you to prescribe optimally effective methods of therapy and medication.
Features of the choice of treatment for sleep disorders in the elderly
Sleep pills are prescribed only to older people who have long-term insomnia. Temporary insomnia does not require drug therapy. Sometimes in such cases a safe herbal-based sleeping pill is prescribed. When prescribing sleeping pills for older people, a number of factors are taken into account:
- decreased metabolic rate (the drug takes longer to leave the body);
- decreased cognitive function;
- concomitant pathologies;
- side effects of sleeping pills;
- taking other medications.
For apnea, barbiturates and tranquilizers are contraindicated, as these drugs aggravate breathing disorders. Benzodiazepine sleeping pills should be prescribed with caution to patients taking medications from the following groups:
- hypotensive;
- cardiac glycosides;
- antidiabetic agents;
- anticoagulants;
- macrolides.
Important! Older people with dementia are not prescribed regular sleeping pills. Even the most modern hypnotics cause the opposite effect in such patients (insomnia and motor agitation). Antipsychotics are prescribed to treat insomnia in dementia.
When treating insomnia drugs for older people, the following rules are followed:
- prescribing the minimum effective dosage;
- short-term course of treatment (3–4 weeks);
- gradual withdrawal of medications;
- use of medications no more than 3 times a week;
- monitoring the patient during treatment.
Preference is given to new generation hypnotics - cyclopyrrolone derivatives. The drugs begin to act quickly, have a short half-life, and are well tolerated by older people.
List of drugs without prescriptions
To improve sleep in case of short-term insomnia, medications for insomnia in old age are prescribed, which are sold without a prescription.
Melaxen (Circadin, Melarena)
Sleeping pills contain the hormone melatonin. Is an adaptogen. The medicine has positive and undesirable effects.
Pros:
- begins to act quickly;
- normalizes biological sleep rhythms;
- reduces the number of night awakenings;
- exhibits an antioxidant effect;
- does not cause addiction.
Minuses:
- cannot be combined with hormonal drugs and MAO inhibitors;
- It is undesirable to stay in the sun for a long time;
- do not prescribe simultaneously with drugs that depress the nervous system and beta-blockers.
Contraindications:
- intolerance;
- severe impairment of renal and hepatic function;
- diabetes;
- lymphoma;
- myeloma;
- leukemia;
- Hodgkin's disease.
Price: from 520 rub.
Reviews from older people about medications with melatonin are mostly positive. Rarely, patients note the negative effects of medications, usually associated with ineffectiveness or the occurrence of allergic reactions.
Analogues: Velson, Melarithm, Sonnovan.
Prices for Melaxen tablets 12 pcs.
Prices for Melaxen tablets 24 pcs.
Donormil
The active substance doxylamine succinate is a histamine H1 receptor blocker. The drug has many side effects and contraindications. Use with caution in old age.
Pros:
- effervescent soluble tablets;
- has a sedative effect.
Minuses:
- the maximum concentration of the substance is reached no earlier than an hour;
- causes dry mouth;
- causes constipation;
- increases heart rate;
- causes urinary retention;
- causes dizziness.
Contraindications:
- glaucoma;
- carbohydrate metabolism disorder;
- difficulty urinating;
- prostate adenoma;
- taking antiparkinsonian drugs, atropine, central antihypertensive drugs, neuroleptics.
Price: from 122 rub.
More often you can find negative reviews from older people about this drug. Many people note lethargy during the day, decreased memory and attention.
Analogues: Reslip, Sondox, Sonmil.
Prices for Donormil tablets 30 pcs.;
Valocordin (Valoserdin, Corvalol)
Sedative drops contain phenobarbital. They dilate blood vessels and have a mild hypnotic and antispasmodic effect. Indicated for functional disorders of the cardiovascular system.
Pros:
- reduces blood pressure and heart rate;
- effective for neuroses;
- eliminates anxiety and feelings of restlessness.
Minuses:
- causes dizziness;
- allergic reactions may occur;
- the appearance of daytime sleepiness;
- psychomotor agitation in case of overdose;
- bromine accumulation;
- in case of overdose: confusion, ataxia;
- addictive.
Contraindications:
- brain diseases;
- traumatic brain injuries;
- liver and kidney failure;
- alcohol addiction;
- taking tranquilizers or antipsychotics;
- prescription of central nervous system stimulants.
Price: from 16 rub. (Corvalol) up to 340 rub. (Valocordin).
Good reviews about medications are more common. Negative responses are associated with inhibition with long-term use.
Analogues: Korvaltab, Korvaldin, Barboval.
Prices for Valocordin drops for oral administration 20 ml;
Prices for Valocordin drops for oral administration 50 ml;
Lungs
Elderly people are recommended to start therapy with drugs that have a mild sedative and hypnotic effect.
Afobazole
Afobazole belongs to the group of anxiolytics. It has a neuroprotective effect, reduces the severity of anxiety and irritability.
Pros:
- does not impair cognitive functions;
- quickly eliminated from the body;
- eliminates neurotic conditions.
Minuses:
- causes allergies;
- dyspeptic disorders (nausea, diarrhea);
- headache;
- The therapeutic effect develops after a few weeks.
Contraindications:
- galactose intolerance;
- treatment with Carbamazepine and Diazepam.
Price: from 390 rub.
Negative reviews are associated with high cost and lengthy treatment. It is not effective for severe sleep disorders.
Analogues: Tenoten, Phenibut, Adaptol.
Prices for Afobazole tablets 10 mg 60 pcs.;
Glycine
The active substance is an amino acid with an inhibitory effect on the central nervous system. Improves metabolism in brain tissue, reduces psycho-emotional stress.
Pros:
- improves cognitive functions;
- helps to sleep;
- reduces the toxic effects of alcohol;
- helps with encephalopathy and ischemic stroke;
- reduces the severity of side effects of neuroleptics and antidepressants.
Minuses:
- may lower blood pressure;
- light sleeping pills.
Contraindication for use is individual intolerance.
Price: from 40 rub.
Doctors speak positively about the medicine, but with the caveat that Glycine should be taken only in combination with other sedatives. May not be effective as a sleep aid for older people.
Analogues: Glycised, Phenibut, Tenoten.
Prices for Glycine sublingual tablets 100 mg 50 pcs.
Symptoms of insomnia in diabetes mellitus
Sleep disorder in diabetes mellitus has pronounced symptoms.
Among the most common symptoms, the most basic are:
- Waking up frequently during the night;
- Waking up very early in the morning;
- Weakness and discomfort;
- Gastrointestinal disorder;
- Impaired concentration.
A person who suffers from insomnia experiences a feeling of drowsiness throughout the day. He is inattentive, makes mistakes in his work, gets nervous, gets irritated for any reason and for no reason. As a consequence of insomnia - frequent headaches, anxiety, and depression.
After a stroke
After a stroke, one of the consequences is sleep disturbance. Insomnia can be triggered by mental pathologies due to cerebral circulatory disorders, apnea, and movement disorders. Insomnia medications should only be given to patients after a stroke after a doctor has written a prescription.
Donormil
The drug helps eliminate depression, which is a common accompaniment of post-stroke conditions. However, when prescribing, a number of side effects and contraindications of Donormil are taken into account. Doctors do not recommend treating insomnia with this drug, as patients may experience decreased cognitive function.
Prices for Donormil tablets 30 pcs.;
Zolpidem (Ivadal, Sanval, Ambien)
Refers to hypnotics, anxiolytics and sedatives. The action is similar to benzodiazepines. Scientists from the Stanford School of Medicine have found that in low doses the drug allows for faster recovery from a stroke by enhancing the activity of nerve cells.
Pros:
- has an anticonvulsant effect;
- an effective remedy even when prescribed minimal doses;
- normalizes sleep stages;
- does not cause drowsiness during the day;
- quickly begins to act.
Minuses:
- the appearance of headache, dizziness, double vision;
- development of paradoxical insomnia;
- anterograde amensia may develop;
- the occurrence of dyspeptic disorders and abdominal pain;
- development of behavioral disorders;
- development of addiction.
Contraindications:
- severe respiratory failure;
- sleep apnea;
- myasthenia gravis;
- allergy to benzodiazepines;
- severe pathologies of the liver and kidneys;
- lactose intolerance;
- simultaneous use of barbiturates, antiepileptic drugs, narcotic analgesics, Buprenofrine, Baclofen.
Price: from 900 rub.
Reviews from doctors about the medicine are positive as effective tablets for insomnia for the elderly. Not recommended for long-term therapy.
Analogs: Hypnogen, Zolsana, Snovitel.
The effect of insomnia on the diabetic body
By evening, the human body gets tired, it needs rest, peace and sleep. However, for reasons that will be described below, many diabetics suffer from insomnia. Sleep disturbance at night negatively affects the patient's body:
- The level of insulin production decreases;
- Blood sugar levels increase;
- A person already feels tired in the morning, because the blood in the vessels (due to the high sugar content) is very thick, which can very roughly be compared to sugar syrup;
- A tired person is unable to perform any work efficiently, including at his workplace;
- Mobility and motor functions decrease.
A sedentary lifestyle, due to chronic fatigue coupled with lack of sleep, leads to weight gain in the patient and obesity, which is incredibly difficult to get rid of. High blood sugar levels lead to the possibility of blood clots and the development of cardiovascular diseases.
Homeopathic
For older people, medications based on natural ingredients are recommended. They do not affect the action of other drugs and have an adaptogenic and restorative effect. This sleeping pill is sold without a prescription.
Nervochel
The homeopathic remedy has a sedative, anticonvulsant and mild hypnotic effect. Contains plant extracts, cuttlefish ink sac substances, phosphoric acid, magnesium, bromides, valerian-zinc salt.
Pros:
- reduces nervous tension;
- helps with psycho-emotional exhaustion;
- relieves headaches;
- can be taken for mental illness;
- normalizes sleep;
- helps eliminate twitching and tremors.
Minuses:
- frequency of administration 3 times a day minimum;
- causes allergies.
Contraindications include allergies.
Price: from 350 rub.
Doctors do not note a strong hypnotic effect of the drug. It is believed that homeopathic medicine does not help with serious neurological problems.
Analogs: Glycine, Grandaxin, Homvio-Nevrin.
Prices for Nervochel sublingual tablets 50 pcs.
Notta
Contains plant extracts, phosphorus, zinc valerate. Available in drops and tablets. Prescribed for neurological disorders and insomnia.
Pros:
- relieve increased excitability;
- normalizes sleep;
- has a weak tranquilizing effect.
Minuses:
- not effective for severe insomnia;
- causes allergic reactions.
Contraindicated in case of individual intolerance.
Price: from 300 rub.
There are various reviews about the drug. Many patients do not observe the positive effect of the drug. Doctors prescribe it as an additional drug for the treatment of minor disorders of the nervous system.
Analogs: soothing collection, Novo-passit, Alora.