Normal Sleep in Older Adults In some older adults, sleep and the ability to get solid sleep declines. About 50 percent of older adults complain of sleep disturbances. They are more likely to sleep or nap during the day than younger adults. Clinically, changes in the structure of aging-associated sleep are characterized by decreased sleep efficiency, increased time in bed, prolonged sleep latency, decreased total sleep quality, increased frequency of awakenings and sleep period drift, prolonged duration of nocturnal awakenings, and increased frequency of napping. Anhui Medical? Sleep Disorders and Their Consequences in Older Adults Older adults have an increased prevalence of insomnia during sleep, obstructive sleep apnea, periodic limb movements during sleep, restless leg syndrome, and REM sleep behavior disorder, are prone to sleep phase advancement syndrome, and are more prone to awakening in adverse environments such as noise. Other significant disturbances that may result include increased sleep fragmentation, advancement of cyclic rhythmic phases (e.g., early awakening), decreased melatonin levels, and an altered relationship between sleep-wake rhythms and melatonin release in response to the onset of insomnia. Consequences of sleep disorders in older adults include daytime sleepiness, disturbances in state of mind, increased unexpected events, and can lead to reduced quality of life, alertness, resourcefulness, and cognitive functioning (memory, attention, speed of reaction, concentration). Insomnia in the Elderly and Its Nonpharmacologic Treatment Insomnia is the most common sleep disorder in the elderly. Insomnia is the most common sleep disorder in the elderly. the older the age, the higher the incidence of insomnia, and the more likely to become chronic. the prevalence of insomnia in the elderly over 65 years of age is about 12-40%, and there are more female than male. The relationship between subjective and objective insomnia is weaker in women than in men. Compared with young people (who have more difficulty falling asleep), older patients have mainly sleep maintenance insomnia. It can also be characterized by difficulty falling asleep and early awakening. Causes of insomnia in the elderly include changes in cyclic sleep-wake rhythms (advancement of sleep phase, decrease in amplitude of cyclic rhythm), sleep disorders (obstructive sleep apnea syndrome, restless legs syndrome), medical disorders (acute and chronic pain syndromes, fibromyalgia, chronic obstructive pulmonary disease, ischemic heart disease, congestive heart failure, gastroesophageal reflux, nocturia), neurologic disorders (Parkinson’s disease, dementia , stroke), psychiatric disorders (depression, anxiety), drugs, substance use (alcohol, caffeine), and psychological stressors (retirement, widowhood). All of these causes increase in incidence in old age. Consequences of insomnia in older adults include decreased quality of life, drowsiness, fatigue, mood changes (depression, anxiety) neurocognitive impairment, and impaired balance. Treatment of it consists of 3 aspects: 1. Treatment of the cause This is the key to successful treatment and should be given special attention. For example, many medications used by older adults for other conditions can cause insomnia (see separate article). In hypertension alone, the use of preparations containing reserpine or colistin or diuretics is so common that they have become self-help medications for many patients. All of these ingredients can lead to insomnia or even depressive disorders, and if their use is not stopped, the insomnia is difficult to disappear. Therefore, elderly insomnia patients should ask whether there is high blood pressure, take what kind of drugs. 2, sedatives In the country, the elderly insomnia patients prescribed sedatives are very common, and many patients require repeat prescription, easy to become long-term use. However, the use of sedatives for symptomatic treatment of insomnia in the elderly may lead to daytime sleepiness, retrograde amnesia, constipation, falls, bone fractures, other accidents, addiction, and an increased risk of death, so the need to be careful in the choice (see separate article), and is not recommended for long-term use (no more than 6 weeks). 3. Non-pharmacological treatments Due to lack of knowledge, these measures are rarely used. However, this type of treatment may produce long-term effects with minimal risk, and is therefore more suitable for the elderly. Non-pharmacological treatments for insomnia include cognitive-behavioral therapy (CBT), self-help therapy, music therapy, physical exercise, light therapy, hypnosis, and acupuncture. Sometimes a combination of pharmacologic and non-pharmacologic treatments is needed. In addition, tai chi and yoga may be effective for insomnia. a. CBT aims to enhance sleep by changing bad sleep habits and eliminating negative attitudes and beliefs about sleep. There is limited evidence that older insomnia patients treated with CBT show only mild efficacy, and are less effective than younger patients.CBT consists of a group of approaches ranging from educational packages to purely behavioral interventions. The most prominent are sleep hygiene education, stimulus control, muscle relaxation, sleep restriction, and paradoxical ideation. (1) The purpose of sleep hygiene education is to help patients understand how lifestyle habits such as food, exercise, and medications, as well as environmental factors such as light, noise, and temperature, affect sleep. However, these factors usually only exacerbate insomnia. Common educational content includes: do not drink tea and coffee in the afternoon, smoking; avoid alcohol in the evening; do not nap before bedtime; avoid eating indigestible food before bedtime; regular exercise but not within 3-4 hours before going to bed; minimize the impact of light, noise and heat on sleep; do not lie in bed for long periods of time in the wakefulness state; and learn about the age-related changes in the duration of sleep in order to reduce the expectation of sleep. ② Stimulus control is to help the patient establish a reconnection between bed and sleep. Ask the patient to go to bed only when drowsy; use the bed only for sleep; if not asleep within 15-20 minutes of going to bed, get up and perform relaxation activities until you feel sleepy before going to bed again, or several times throughout the night if necessary; get up at regular intervals throughout the day (regardless of how long you slept the previous night); and do not sleep during the day. ③Muscle relaxation therapy is an exercise of alternating muscle tension and relaxation under professional guidance to promote muscle relaxation and inhibit anxiety-related arousal. (4) Sleep restriction therapy is to determine the amount of time the patient spends in bed according to the average daily sleep time in the previous 2 weeks, and no daytime sleep is allowed. Sleep efficiency is evaluated weekly, and bedtime is extended for 15-20 minutes when it reaches 90% or more and is maintained for 5-7 days, and shortened for 15-20 minutes when it falls below 80% until the optimal sleep time is reached. ⑤ Ambivalent ideation is an intentional effort to maintain arousal in order to reduce bedtime anxiety and promote sleep onset. Generally speaking, the efficacy of the composite program is better than any single program. b. Self-help therapy Self-help therapy, a type of psychotherapy that can be done independently by the patient, allows for various forms of self-help interventions, such as books, the Internet, and audiotapes. Through self-help intervention, sleep and psychological symptoms of insomnia patients of different ages can be mildly-moderately improved. c. Music therapy There are very few studies on the efficacy of music on insomnia in the elderly. A small sample (60 cases) of 3 consecutive weeks of case-control study suggested that sedative (soft and slow) music improved sleep quality, latency, efficiency and daytime impairment of insomniacs at the end of each week. There was no difference between Chinese and Western music. d. Physical exercise It is generally recognized that exercise promotes sleep, but empirical evidence is limited. Only one small-sample (43 cases) study on physical activity in elderly insomniacs. Sixteen consecutive weeks of moderate-intensity physical activity (30-40 minutes of endurance training four times a week) may shorten sleep latency and prolong sleep duration. e. Phototherapy There is a lack of high-quality clinical evidence supporting the effectiveness of phototherapy for chronic primary insomnia in people over 60 years of age. Therefore, light therapy is not recommended for elderly patients with insomnia. There is a lack of high-quality clinical evidence to support the effectiveness of acupuncture treatment for insomnia. More rigorous research is needed on the effectiveness and safety of different forms of acupuncture for the treatment of insomnia.