Seniors' Fear Often Aggravated After Sun Goes Down

In the dark, she is terrified and often doesn’t know where she is or whom she’s with. Across the city, another woman about the same age also fears nights. It’s then that she wonders who might know she’s alone and if they’ll break into her house and rob her.




Seniors' Fear Often Aggravated After Sun Goes Down

During the day, dementia regularly sends the 86-year-old woman into states of confusion. But at night, her situation worsens considerably. In the dark, she is terrified and often doesn’t know where she is or whom she’s with. Across the city, another woman about the same age also fears nights. It’s then that she wonders who might know she’s alone and if they’ll break into her house and rob her.

Whether the causes are physical or psychological, or related to diseases such as Alzheimer’s disease or other dementias, nighttime can be a frightening time for seniors, especially those who are living alone.

Many of these problems that occur with seniors at night are rooted in the physical changes that take place as the result of aging. And those issues are often connected to sleep disorders.

In a 2005 Gallup poll of 1,000 adults over the age of 50, less than half of those surveyed (32 percent) reported getting a good night’s sleep all seven days of the week. And yet, respondents ranked good sleep as more important even than interpersonal relationships.

This Gallup study revealed a number of factors to explain sleep problems including that of worry, according to Dr. Harrison Bloom, senior associate and director of the Clinical Education Consultation Service of the International Longevity Center USA in New York City.

Bloom, a geriatrician, is interested in efforts to help seniors and healthcare providers identify solutions to sleep-related disorders in older individuals.

A local senior care company has discovered that one answer is companionship. “The seniors that we serve often face challenges at night that can disturb their sleep as well as their peace of mind,” says Andrew Garrean, owner of the Home Instead Senior Care office serving Tulsa.

“That’s why our caregivers are regularly called upon to provide overnight care for seniors, to assist them with the anxiety that can set in at night.” Caregivers help with various non-medical tasks such as companionship and are available daily for a few hours or all day.

Seniors’ sleep problems are rooted in many sources. “There are physiological changes occurring with age, such as a decreased amount of time spent in some stages of sleep,” Bloom says. “And many tend to have diseases that can make sleep difficult.

For instance, people who suffer from congestive heart failure can’t rest in a flat position, and the pain of arthritis keeps some awake at night. Medications for certain diseases also can impact sleep, and bladder or prostate problems prompt people to get up for bathroom breaks. These types of interruptions can fragment sleep.”

Dr. Sonia Ancoli-Israel, professor of psychiatry at the University of California at San Diego and director of the Sleep Disorders Clinic at the Veterans Affairs San Diego Healthcare System, agrees it’s not necessarily the aging process that disturbs sleep, but rather those changes that accompany getting older.

“In addition to those medical illnesses and medications common in older adults, there can be psychiatric problems and changes in circadian rhythms.” Ancoli-Israel says.

Circadian rhythms are body rhythms that help determine when we sleep and they change as we age. Ancoli-Israel conducted a study five years ago that exposed patients with dementia living in nursing homes to either morning or evening bright light in an effort to adjust the body’s circadian rhythms. Both techniques improved nighttime sleep.

Even though research is helping to identify solutions, statistics indicate that more seniors are searching for medical remedies to sleep problems. Between 2000 and 2004, use of prescription insomnia drugs climbed by 16 percent among people 65 years and older, according to an analysis released recently by the prescription-management firm Medco Health Solutions of Franklin Lakes, N.J.

However, while many aids are on the market, sleep medications might not be the best answer for all older adults, as some may make seniors confused and disoriented, symptoms that, in particular, should not be exaggerated in seniors who already are confused due to Alzheimer’s disease or other dementias.

In fact, those symptoms can wreak nighttime havoc in the lives of seniors and family caregivers, according to Dr. Sharon Brangman, professor of medicine and division chief, Geriatrics, at SUNY Upstate Medical University in Syracuse, N.Y.

“I have an 80-year-old Alzheimer’s patient who is very anxious and nervous during the afternoon. She then naps in front of a television in the evening and doesn’t want to sleep at night,” Brangman said.

Her husband is her primary caregiver, and he’s exhausted at the end of the day. But he’s afraid to sleep at night because she might wander. When she goes to sleep, he often lets her sleep until noon. We’ve tried to encourage him not to let her sleep during the day, and suggested activities for her and respite breaks for him.”

While the issues surrounding older adults with dementia-related illnesses are very different from seniors with sleep disorders and physical ailments, all of those factors can contribute to the psychological anxiety that seniors may experience at night.

“Many seniors undoubtedly are anxious because they know it’s harder to reach help at night,” Ancoli-Israel said. “And there’s more time to think about the things that might be going wrong.”

That’s why companionship can help with the anxiety that often accompanies nighttime problems, according to Home Instead Senior Care. “The 86-year-old woman with dementia who awoke at night was reassured by an overnight caregiver,” said Home Instead Senior Care’s Garrean. “And for the woman who was constantly afraid of being robbed at night, efforts were made to secure her home including lighting the front and back of her house. It’s those kinds of extras that can make the difference between seniors having peace of mind or being afraid in their own homes.”