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Combat Sleep Problems as You Age

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We often hear from older friends and family – or perhaps from yourself – “I had a terrible sleep last night.” Sleep patterns tend to change, and that is perfectly normal as we grow older. Research shows that older adults may require less sleep than in younger years as they typically experience decreased physical activity.

However, not all changes in sleep patterns are normal. Some sleep problems manifest due to underlying and sometimes undiagnosed medical problems. Arthritis and osteoporosis, digestive issues, incontinence, medication side effects, COPD, even a long-term effect of COVID-19 can affect sleeping quality. It is important to address and manage these conditions to improve sleep because lack of proper rest may lead to irritability, depressions, high blood pressure, memory loss, and decreased alertness that can lead to unintentional falls or car accidents.

Understanding Aging and Sleep Issues 

If you experience insomnia often and feel sleepy during the day, take stock of your lifestyle. Get more physical exercise, improve your sleep environment, put away digital devices and television earlier, and avoid caffeine and alcohol contributing to better sleep patterns. If you experience significant anxiety, consult your doctor as medication may be necessary. The blog Right at Home has suggestions for promoting better sleep at 10 Tips for Improving Sleep Quality. 

Sleep apnea, snoring, and other forms of sleep-related breathing disorders (SRBD) are a spectrum of breathing problems while asleep. Sleep apnea is common, usually appearing in middle age, and is associated with other health-related issues. The frequent pausing of breath, most commonly obstructive sleep apnea, is associated with snoring. Experiencing SRBD is associated with poor health problems and outcomes such as coronary artery disease, heart failure, stroke, and an increase in mortality.

During sleep, it is normal to shift position. However, abnormal movements are known as Sleep-related movement disorder (SRMD) and may significantly disturb your sleep or your partner’s. Restless leg syndrome is the frequent moving of limbs to quell unpleasant sensations in the legs. Clenching the jaw or grinding teeth during sleep is called bruxism and can increase blood pressure. These movement disorders often accompany other sleep-related issues. A leg cramp is not an SRMD. Experiencing sleep-related leg cramping is often idiopathic or can be related to a deficiency in vitamins or minerals.

A pattern of daytime napping becomes more prevalent in older adults but can lead to nighttime sleep disruption. However, if a day is unusually active, a nap may be appropriate and beneficial. Many cultures consider napping a routine daily activity; however, these cultures typically keep different hours than most Americans. Daytime napping can occur because of a partner’s restless, unhealthy sleeping patterns disrupting their sleep. Using earplugs or moving into a different room are ways to address second-hand sleep problems. 

If you provide care for a spouse or older relative with dementia problems, you may notice sundown syndrome. A person with dementia may exhibit restlessness, agitation and be hyper awake in the late afternoon and early evening. The individual may resist going to bed and refuse to stay in bed, getting up repeatedly throughout the night, increasing the chance of injury and exhausting their caregiver. Sundown syndrome may indicate that it is time to move the individual with dementia to a full-time monitored care facility.

Sleep disorders due to Alzheimer’s disease and other dementias can pose special considerations as brain deterioration affects how the brain sleeps. Less time in deep sleep and more awake time during the night causes issues with the circadian rhythm. And while lack of sleep can worsen thinking and behavior in everyone, for those with dementia, these consequences are all the more serious with an increase in irrational and emotional instability, which already presents a problem.

The Importance of Being Proactive about Sleep Issues

Make healthy sleep a priority by keeping a routine that trains your brain to release sleep hormones called melatonin at the right time. Commit to a bed and wake-up time every day and ensure your sleep environment is a restful one. Relaxing activities such as reading, listening to calm music, a warm bath, or meditation can help the body unwind from the day’s activities and promote good sleep. Be sure to power down all digital devices like tablets, computers, phones, even TVs which can suppress melatonin early in the evening hours.  Sleep problems in later years may change but should not significantly affect your rest and may indicate an underlying medical condition. 

Sleep specialists can evaluate, diagnose and offer courses of treatment for a wide variety of sleep problems. Managing medical conditions and employing good sleep guidelines can bring you healthy, restful sleep. Control the things that you can, assess your sleep quality, and make adjustments to improve your sleep experience. You will feel better, think more clearly, and make better decisions with proper rest.

We hope you enjoyed this article. Please contact our Ruston, LA office by calling us at (318) 255-1760 or schedule an appointment to discuss how we can help with your planning needs.

Alzheimer’s Patients and the Risk Overmedication

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While is is extremely common for elderly Americans to use a multitude of prescription medications at once, the more medications a person takes, the higher the risk of dangerous drug-drug interactions. There is also an increased possibility of inappropriate prescribing, adverse drug reactions, hospitalization, and even death. Patients who have Alzheimer’s disease (AD) or other forms of dementia often take dangerous combinations of doctor-prescribed medications, increasing their risk of further mental deterioration, dangerous drug interactions, unintentional falls, and overdoses.

What is Alzheimer’s Disease?

Alzheimer’s disease presents itself with neurofibrillary tangles and amyloid plaque in the brain. Thus far, the most successful treatment course is pharmacologically based. These medicines target the central nervous system (CNS) through the brain-blood barrier (BBB) in nearly every case. The medications affect the complex processes of continuous cross-talk between the cells that constitute the BBB and the CNS.

The Prevalence of Overmedication with Alzheimer’s Patients

There is a dangerous trend of overmedicating, particularly problematic for the one in seven people living with dementia taking three or more medications who live outside of a nursing home or other professionally monitored environments. Many of these prescription drugs include opioids which seem to present the most troubling combinations of drug therapies. The US Department of Health & Human Services, through the National Institute on Aging (NIA), outlines some basic information regarding managing medicines for a person with Alzheimer’s disease.

Health Day News reports lead study researcher Dr. Donovan Maust, associate professor of psychiatry at Michigan Medicine, says, “About half of the top 20 combinations included an opioid plus other CNS (central nervous system) depressant medications.” The University of Michigan’s study focus was analyzing 2018’s Medicare prescription data for more than 1.2 million people with dementia. At the University of Michigan’s Academic Medical Center, the report shows that individuals older than 65 should not take three or more prescribed CNS active medications simultaneously as drug interactions can be potentially dangerous, even fatal.

Despite these findings, nearly 14 percent of dementia patients took three or more CNS active drugs concurrently for at least one month. Of that same group, almost 58 percent of patients were on at least three overlapping medicines for more than half the year, while seven percent took three or more for the entire year. Study findings report that the most common drug combination included at least one antidepressant, one antipsychotic, and one anti-epileptic. More than nine of ten patients who took three or more medications took an antidepressant, and nearly two-thirds were taking an anti-seizure drug.

In the same Health Day News report, Maust says, “Obviously, it’s very concerning for patients with dementia that you’d be giving them medications that actually seem to cause further deterioration in their cognition.” This study’s findings were published on March 9, 2021, in the American Medical Association Journal (JAMA). While overmedication is troubling and potentially dangerous, there is also concern about pain being undertreated in older adults, particularly those with Alzheimer’s who may have difficulty articulating their pain.

How to Avoid Over Medication

An Alzheimer’s patient’s physician should routinely conduct a comprehensive medication review (CMR) to limit multiple prescriptions’ harmful effects. The purpose of the evaluation is to have one doctor evaluate all of the medications taken. A CMR appointment must be explicitly scheduled as most medical offices slot appointments in 15-minute increments, which is too short to review several medications. A complete list, including non-prescription drugs, is essential for a comprehensive medication review. A doctor treating older Alzheimer’s patients might change dosage amounts because of the potential for further mental confusion. Changes in dosage may also be prudent as more senior bodies process medications differently and often less efficiently in the digestive system, kidneys, and liver.

Dr. Maust believes that many of the drugs used to treat Alzheimer’s disease may pose more risk than benefit for a patient when taken in combination. Evidence points to instances when antidepressants and antipsychotics may contribute to reasoning and memory loss among dementia patients and other problems. Despite all the research, there is no known cure for Alzheimer’s disease. Meanwhile, it is unclear if the benefits of pharmacology treatments outweigh the risks posed by their prescription.

While we can’t help with prescriptions interfering with one another, we can help people with Alzheimer’s in a number of ways. We help people plan for the possibility of needing care in the future. We help them determine who will make decisions if they can’t. And we explore payment options like Medicaid or the Veterans’ Administration if paying privately for care will result in severe financial hardship. Please contact our Ruston, LA office by calling us at (318) 255-1760 or schedule an appointment to discuss how we can help with your specific situation and needs.

Five Facts About Dementia Caregiving in Louisiana

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Dementia, in particular, the prevalence of Alzheimer’s Disease in the American population, is creating difficult caregiving experiences for the family members who are primarily responsible for providing care. Even though you understand your loved one’s dementia behaviors are a symptom of the disease and not intentional or personally targeted to you, coping with them is often emotionally, financially, and physically challenging. Psychology Today reports caregivers routinely say, “Nobody really understands how hard caring for a loved one with dementia is!”

First Fact: Most Care is Provided to Someone with Dementia

Psychology Today is also reporting five facts that you should know about dementia caregiving, particularly since its incidence is increasing in the United States. The first fact is nearly half of all people who provide care do so for someone with dementia. The statistic is 48 percent of caregivers are providing for those who have Alzheimer’s Disease, Vascular Dementia, Lewy body dementia, and more. Additionally, dementia is typically not the only ailment a loved one suffers from, and dementia can have long phases from preclinical to its last stage, making caregiving a long-term commitment. The complexity, hours, and level of care needed throughout the stages of dementia are staggering.

Second Fact: Most People with Dementia are Not Living in Nursing Homes

A second fact about dementia caregiving is that most people with dementia are not living in a nursing home or assisted living but rather with a family member. Most Americans aged 65 or more live in the community, with only about 4.5 percent (roughly 1.5 million) of older Americans living in nursing homes and 2 percent (1 million) in assisted living facilities, according to the National Institutes of Health (NIH). These home care providers are more than two-thirds of women (67 percent), and more than one-third of these are daughters.

Third Fact: Care Requirements are Needed 24/7

Dementia, in particular Alzheimer’s, is the most expensive disease in America, costing more than heart disease and cancer. This third fact is unsurprising as care requirements are often needed 24/7 for years. The Alzheimer’s Association (alz.org) Fact Sheet reports that in 2020 caring for those with Alzheimer’s and other dementias cost American society an estimated 305 billion dollars. While much of this cost is born through Medicare and Medicaid spending, for caregivers, there is still an out-of-pocket expense that is nearly twice that of caregivers providing care for other conditions. Caregiver payouts can include medical care, personal care, respite care, household expenses, and more.

Additionally, the rate of progression of dementia disease varies widely. On average, a person with Alzheimer’s will live between three to eleven years post-diagnosis. Yet there are some cases where patients survive twenty or more years. Typically, a caregiver for a loved one with dementia will provide care one to four years longer on average than caregivers of other conditions.

Fourth Fact: Dementia Caregivers Work Multiple Hours a Week

The majority of these dementia caregivers are still working in formal employment. The fourth fact is 60 percent of dementia caregivers are working about 35 hours a week. Dementia caregivers are pushed beyond normal limits to provide a loved one’s care nearly 24/7 while still maintaining roughly full-time work. Since an average dementia caregiver spends over eleven thousand dollars a year out-of-pocket providing care, there is little wonder about the necessity of almost full-time employment.

Fifth Fact: Dementia Caregivers Tend to Experience Stress and Anxiety

Finally, the fifth fact is that dementia caregivers suffer higher rates of stress, anxiety, and depression than caregivers tending to other medical problems because of their enormous workload and responsibility. Dementia caregivers also experience more health problems than those caring for other medical diagnoses. It is easy to understand this is the case due to the high-level of caregiving, nearly full-time work, and expenditures that are expected of them.

These five facts about dementia caregiving outline the need for caregiver resources and encouragement. Dementia care providers must tend to themselves during their journey of caregiving to persevere. If you know a dementia caregiver or have one in your family, consider what they go through as it is profound. Listen to their stories. Ensure they receive education about the best ways to approach their intense workload and help them identify national and local resources. Community support and understanding are essential for success in a dementia caregiver’s journey.

If you or a loved one has been diagnosed with dementia, we can help navigate how to find appropriate care, how to pay for it, and how to protect your home and savings. We welcome the opportunity to talk with you further, please contact our office by calling us at (318) 255-1760 and schedule an appointment to discuss how we can help you with your planning needs.