Residential and nursing homes and institutions

Disrupted sleep at night is often the cause of elderly people requiring long-term residential and nursing home care, but the environment that these institutions provide frequently exacerbates the sleep disruption.

Lack of exercise, naps during the day, being put to bed early in the evening, noise and light exposure atnight, with little exposure to light during the day, and wakening at night, for instance to reposition the subject, may all contribute to sleepiness during the day, insomnia at night and to waking feeling agitated, particularly if dementia is also a problem. Exposure to light during the day decreases the sleep latency, causes fewer nocturnal awakenings and increases daytime activity and alertness. Unrecognized sleep disorders such as obstructive sleep apnoeas may also contribute to sleep-related symptoms.

Cholinesterase inhibitors which are commonly prescribed for dementia also cause insomnia as well as intense dreams through their REM sleep promoting action. Conversely, antipsychotic drugs, often prescribed at least partly for their sedative effect at night, will increase daytime sleepiness. This is also the problem with most hypnotics except those with a short duration of action.

Daytime sleepiness increases the risk of accidents and falls, but insomnia and getting out of bed at night also contribute to this.

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