October 2, 2024

Last Wednesday,  September 25th, we had an hour-long webinar on “A Good Night’s Sleep — Especially for Caregivers." If you missed it or you were there and want to review some of the information shared, here’s a summary of the presentation and also the link to the recording. We hope this is helpful in your challenging and important work as caregivers for older adults.

The presentation was in 3 parts:

Part 1: Special challenges and suggestions for Caregivers to help them and their care receiver get a good nights’ sleep. Given by Dr. Susan Musicant, DPT, board-certified geriatric specialist and Injury Prevention Coordinator for DayBreak Adult Care.

Part 2: “Medications and their Impact on Sleep for Elderly Adults”; given by Dr. Adrian Wong, R. Ph., Assistant Professor of Pharmacy Practice, Touro University, California.

Part 3: “Non-medication Behavioral Health Approach to a Good Night’s Sleep."  Given by Dr. Gowda, a licensed clinical health psychologist who is board certified in behavioral sleep medicine.

Part 1:

GOOD HEALTH HABITS include:

Exercise, Nutrition, Sleep, and a Purposeful meaningful life.

RESTORATIVE SLEEP can help PREVENT:

• Chronic health problems: Sleep deficiency can increase the risk of heart disease, kidney disease, high blood pressure, diabetes, stroke, depression, and obesity.
• Immune system: Sleep deprivation can prevent the immune system from building up its forces, making it harder to fight off illness.
• Appearance: Sleep deprivation can make you look older. 
• Weight gain: Sleep deprivation can lead to weight gain and obesity.
• Cravings: Sleep deprivation can lead to cravings for carbohydrates, alcohol, and sugar.

How to prepare your care receiver for sleep, so YOU can sleep:

1. They’ve gone to the bathroom before getting in bed.
2. They can use the bathroom, urinal, and bedside commode if needed during the night (if they are capable).
3. They are not hungry (or too full from eating late).
4. They’ve gotten some sunshine during the day. (if that’s possible)
5. They’ve gotten some exercise during the day.  (If that’s possible)
6. You’ve helped them know they are safe and that you are there
7. You’ve given them the appropriate medications as advised by their doctor for sleep.
8. Have motion detector night lights near bed and/or on way to bathroom.
9. Have a bedside commode or urinal at the bedside if the care receiver is capable of using it.
10. You have an ALERT SYSTEM to wake you up if they urgently need assistance
11. Hire or recruit someone else to be “on duty” during the night—if possible!

 Alert systems or devices to help caregivers sleep better:

• Alarm pads: Bed, floor or seat alarm pads 
• Motion sensor alarms or fall monitors with accelerometers—think Alice in Wonderland, “Help, I’m falling!”
• LED motion sensor light, next to bed

Floor pad: (link)

Bed or chair pad: (link)

To be worn by care recipient: 

(link)

Fall detection light for next to bed: (link)

Smart watch - for fall detection: (link)

Smart watch with or without fall detection capability

Basic Ingredients for Getting and Staying Asleep

(for you and your care receiver):

1. Cool, quiet, dark room
2. Not hungry (but not full from a big meal)
3. Avoid alcohol before bed 
4. Calm emotions (use meditation apps, or self soothing)
5. Avoid daytime sleeping (if possible)
6. Avoid caffeine several hours before bedtime
7. Bedtime routine
8. No medical issues interfering with your sleep—example: sleep apnea - check with your doctor if you suspect you may be not breathing (or holding your breath and then gasping for air) while sleeping
9. Use guided meditation to calm your mind and get ready to sleep
10. Follow your doctor’s advice regarding medication for sleep.

Also, before bedtime—during the day:

• Get exercise during the day.
• Get out into the sunlight.
• Stay in touch with friends and family.
• Have some fun.

Part 2:

“Medications and their Impact on Sleep for Elderly Adults”; given by Dr. Adrian Wong, R. Ph., Assistant Professor of Pharmacy Practice, Touro University, California.

1. Quality sleep is crucial for maintaining health, cognitive function, and overall quality of life in elderly adults and caregivers.

2. Changes in sleep patterns are common with aging, and medication use can significantly affect sleep quality and patterns.

3. Common Sleep Disturbances in the Elderly

• Insomnia: Difficulty falling or staying asleep. Frequent awakenings during the night.
• Sleep Apnea: Interrupted breathing during sleep. Associated with excessive daytime sleepiness.
• Restless Legs Syndrome (RLS): Uncomfortable sensations in the legs with an urge to move them. Disrupts the ability to fall and stay asleep.
• Circadian Rhythm Disorders: Changes in the sleep-wake cycle. Often results in early morning awakenings and daytime sleepiness.

Types of Medications Affecting Sleep

• Benzodiazepines. Used for anxiety and sleep disorders. Can cause prolonged sedation, impaired cognitive function, and the risk of dependence. Examples: Diazepam, Lorazepam.
• Antihistamines are used for allergies and cold symptoms. Can cause drowsiness but may also disrupt sleep architecture. Examples: diphenhydramine, chlorpheniramine.
• Antihypertensives Blood pressure medications sometimes interfere with sleep. Certain types, like beta-blockers, can affect sleep patterns. Examples: Metoprolol, Atenolol.
• Diuretics Used to manage fluid retention and hypertension. Can cause nocturia (frequent nighttime urination), disturbing sleep. Examples: Furosemide, Hydrochlorothiazide.
• Corticosteroids Used for inflammation and autoimmune conditions. Can cause insomnia and mood changes. Examples: Prednisone, Dexamethasone.

Mechanisms of Sleep Disruption:

• Altered Sleep Architecture. 
• Medications can affect REM sleep and the proportion of deep sleep. 
• Impact on Sleep Latency: Some medications increase the time it takes to fall asleep.
• Increased Nocturnal Awakenings Medications may cause frequent awakenings during the night. 
• Daytime Sleepiness: Some medications can cause drowsiness, leading to daytime napping and potential impact on nighttime sleep.

WITH YOUR DOCTOR’S GUIDANCE:

Strategies for Managing Medication-Related Sleep Issues

• Medication Review Regularly: Review all medications with healthcare providers. 
• Consider alternatives or adjustments to minimize the impact on sleep.
• Timing of Medications: Take medications at times that minimize disruption to sleep (e.g., avoid taking diuretics before bedtime).

Non-pharmacological Approaches 

• Cognitive Behavioral Therapy for Insomnia (CBT-I).
• Sleep hygiene practices (e.g., regular sleep schedule, creating a restful environment). 
• Monitoring and Follow-Up: Regular follow-up with healthcare providers to assess the impact of medications on sleep and make necessary adjustments.

Case Study Example

Patient Background: An 80-year-old woman with insomnia and hypertension. 

• Medication Review: Taking a benzodiazepine for sleep, antihypertensive (beta-blocker), and a diuretic. 
• Assessment: Poor sleep quality, frequent awakenings, and daytime drowsiness.
• Interventions: Switching to a non-benzodiazepine sleep aid. Adjusting timing of diuretics. Implementing Cognitive Behavioral Therapy for Insomnia (CBT-I) and sleep hygiene strategies. Outcome: Improved sleep quality and reduced daytime drowsiness.
• Summary: Medications can significantly impact sleep in elderly adults, with both direct and indirect effects. A comprehensive approach involving medication review, lifestyle adjustments, and non-pharmacological treatments can help manage and mitigate sleep disturbances. TALK TO YOUR DOCTOR!

Part 3:

“Non-medication Behavioral Health Approach to a Good Night’s Sleep." Given by Dr. Gowda, a licensed clinical health psychologist who is board certified in behavioral sleep medicine.

Sleep needs as we age:

Sleep Architecture:

• Wakefulness
• Rapid Eye Movement (REM)
• Non-REM
• Stage 1
• Stage 2

SLEEP OVER THE LIFESPAN

• Children have more deep sleep and fewer and shorter awakenings
• Older adults have less total sleep, less deep sleep and more awakenings (more fragmentation)

Stress and Sleep:

• Sympathetic nervous system Prepares us for action. Daytime (hopefully) — ALERT AND READY 
• Parasympathetic nervous system Prepares us for rest and digestion — RELAXED AND RESTORATIVE 

RELAXATION FOR SLEEP TO UNFOLD - The meat of the matter!

• DIAPHRAMATIC BREATHING
• BODY SCAN
• PROGRESSIVE MUSCLE RELAXATION
• GUIDED VISUALIZATION and IMAGERY
• MEDITATION AND MINDFULNESS
• PRAYER
• STRETCHING
• FOAM ROLLING
• BACK YOGA
• TAI CHI
• MASSAGE
• ACUPUNCTURE

CONSTRUCTIVE WORRY:

• Schedule a time and place to “worry”
• Not in your bed or bedroom!
• At least 2-3 hours before your bedtime
• List concerns or “worries” on one side of the page
• Write down the “next step” for each concern on the other side of the page
• Identify what is and is not in your control
• If most of worries are outside your control, shred list when done
• If awake and worrying at night, remind yourself that...
• You have already “taken care of it.”
• You addressed concerns when you were “at your best.”
• Solutions often appear when we are NOT actively thinking
• You will have time to “worry more” tomorrow

Watch the webinar recording below:

1) UCLA Sleep for older adults. https://www.uclahealth.org/medical-services/sleep-disorders/patient-resources/patient-education/sleep-older. 

2) 5 Best Monitoring Systems for Older Adults (2024): NCOA - with Table 1 Comparison of the top monitoring systems for older adults, as of September 2023. https://www.ncoa.org/adviser/medical-alert-systems/best-elderly-monitoring-system-in-home-use/.

3) How Sleep Affects Your Health—NIH (National Institute of Health) https://www.nhlbi.nih.gov/health/sleep-deprivation/health-effects.

4) What Is Sleep Quality? National Sleep Foundation 

https://www.thensf.org/what-is-sleep-quality/#:~:text=Most%20adults%20need%20somewhere%20between,you%20need%20from%20your%20slumber.

5) National Geographic: 6 of the best sleep trackers, from rings to smart watches

https://www.nationalgeographic.com/lifestyle/article/best-sleep-trackers.

Great Free Resources:

• Free app for VA - Insomnia Coach: The Insomnia Coach app was created for everyone, including Veterans and Service members, to help manage insomnia. The app is based on Cognitive Behavioral Therapy for Insomnia (CBT-I).
• Calm - “Wind Down Sessions” Many of these are free.
• National Institute of Health: (NIH) - Sleep Studies. They will give you a good start on how to relax into sleep. 

At DayBreak, we are dedicated to improving the quality of life for elders and family caregivers in our community. We aim to empower and support them as they navigate challenges with dignity.

If you know an elder in need of our care and coordination services, or a caregiver seeking support, please encourage them to reach out to us at: 

510-834-8314