When The Sun Goes Down, Seniors' Fears Often Take Center Stage

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.  And 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 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, only 32 percent reported getting a good night’s sleep all seven days of the week.  And yet respondents ranked good sleep as being more important even than interpersonal relationships.

According to Dr. Harrison Bloom of New York City’s International Longevity Center – USA, this Gallup study revealed a number of factors to explain sleep problems – including worry.  Bloom, a geriatrician, is interested in efforts to help seniors and healthcare providers identify solutions to sleep-related disorders in older adults.

Seniors’ sleep problems may be rooted in many sources.  “There are physiological changes occurring with age, such as a decreased amount of time spent in some stages of sleep,” says Bloom.  In addition, he lists several other barriers that can limit quality sleep for seniors:

• Congestive heart failure, which prevents people from resting in a flat position;
• Arthritis pain, which can keep sufferers awake;
• Bladder or prostate problems that prompt people to get up for repeated bathroom breaks; and,
• Even medications for certain diseases can impact sleep.

Dr. Sonia Ancoli-Israel, professor of psychiatry at the University of California at San Diego and a sleep disorders expert, agrees it’s not necessarily the aging process that disturbs sleep, but rather those changes that accompany getting older.  She explains, “In addition to those medical illnesses and medications common in older adults, there can be psychiatric problems and changes in circadian rhythms.”

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

Nonetheless, even though research is helping to identify solutions, statistics indicate that more seniors than ever are searching for medical remedies to sleep problems.  For example, between 2000 and 2004, use of prescription insomnia drugs climbed by 16 percent among people 65 years and older, according to an analysis by the prescription-management firm Medco Health Solutions of Franklin Lakes, NJ.

However, while many such 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.  These are symptoms that, in particular, should not be exaggerated in those 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 at SUNY Upstate Medical University in Syracuse, N.Y.  Brangman explained that one of her patients is an 80-year-old woman with Alzheimer’s who suffers from anxiety during the day, and then takes a nap in front of the television in the evening.  Consequently, she has no desire to sleep at night.

Brangman said of this patient, “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 pertaining to older adults with dementia-related illnesses are different from those affecting seniors with sleep disorders and physical ailments, all of these factors can contribute to the psychological anxiety that seniors may experience when darkness falls.  Ancoli-Israel says, “Many seniors undoubtedly are anxious because they know it’s harder to reach help at night.  And there’s more time to think about the things that might be going wrong.”

The good news is that frightened older adults typically benefit tremendously from nighttime companionship.  In fact, the seniors served by our franchise often face challenges at night that can disturb their sleep as well as their peace of mind.  That’s why our Home Instead CAREGivers are regularly called upon to provide evening or overnight care for seniors – including those with Alzheimer’s and other dementias – and to assist them in dealing with the anxiety that can accompany the onset of darkness.  These CAREGivers help with various non-medical tasks and are available daily to provide care for just a few hours or around the clock. 

This seems like a pretty simple response to a very complicated problem, so you might ask, “Does it work?”  Well, the 86-year-old woman with dementia who awoke at night was very effectively reassured by a regular overnight CAREGiver.  And for the woman who was afraid of being robbed, along with providing her with overnight companionship, efforts were made to secure her home – including lighting the exterior 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.

ten ways to help seniors avoid night fright

These tips from Home Instead Senior Care and senior care professionals can help older adults feel more secure at night:

• Encourage seniors to obtain a lifeline, which is a button they can push to summon medical help if they need it.
• At night play soft music which has a calming effect.
• Install night lights to make it easier for seniors to see when they get up at night.
• Light the outside of the house and set timers to activate some indoor lights. Older adults feel more secure knowing their house is illuminated.
• Let your older loved ones know they can call you. Put your number or that of another family member or friend on speed dial.
• Reassure them the house is secure and rehearse them on the process to make sure their doors and windows are locked.
• Make sure the interior of the house is safe by installing grab bars and getting rid of throw rugs.
• Consider climate control but make sure the house isn’t too hot or too cold.
• Encourage a set routine which helps a senior feel less anxious.
• Hire a caregiver who can provide assistance from a few hours a day to 24 hours, seven days a week.

Information gathered and provided by: Home Instead Senior Care, Inc.